455002659-10-8-2024-59-AS-KHOS-DA6NQL-20241018104006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002659
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:49:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240715154422

FACILITY NAME:	CAZADERO HOME, INC		FACILITY NUMBER:	455002659
ADMINISTRATOR:	OSTERMAN, RUSSELL		FACILITY TYPE:	735
ADDRESS:	3556 CAZADERO WAY		TELEPHONE:	(530) 262-5002
CITY:	ANDERSON	STATE: CA	ZIP CODE:	96007
CAPACITY:	6	CENSUS: 1	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	ANGEL DOSS		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Chemicals are not locked and inaccessible to clients.
Medication Mismanagement.
Client needs a higher level of care.

INVESTIGATION FINDINGS:

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On 10/08/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 07/15/24. LPA Gurriere met with Angel Doss, and explained the purpose of the visit.

Chemicals are not locked and inaccessible to clients.

During the interview process, the licensee, the administrator, the regional center service coordinator, and a staff person were interviewed. In addition, LPA Benson conducted a walkthrough during the initial visit. Client documents were received and reviewed to include the Physician’s Report, Individual Program Plan (IPP), client progress notes, and the Medication Administration Records (MARs).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240715154422

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CAZADERO HOME, INC	FACILITY NUMBER: 455002659
	VISIT DATE: 10/08/2024

NARRATIVE

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During the investigation, it was reported by all staff persons that the chemicals are locked and are inaccessible to the clients. In addition, LPA Benson conducted a walk through and verified that the chemicals were locked in a cabinet in the garage.

Medication Mismanagement.

During the interview process, the licensee, the administrator, the regional center service coordinator, and a staff person were interviewed. In addition, LPA Benson conducted a walk through during the initial visit. Client documents were received and reviewed to include the Physician’s Report, Individual Program Plan (IPP), client progress notes, and the Medication Administration Records (MARs).

During the investigation, staff reported that the allegation is untrue. It was reported that the facility policy is to have a “two person staff sign off” when administering the client’s medications; in which the staff follow. The MARs were reviewed and did not indicate that there was a medication mismanagement, nor did it indicate that there was a medication error.

Client needs a higher level of care.

During the interview process, the licensee, the administrator, the regional center service coordinator, and a staff person were interviewed. In addition, LPA Benson conducted a walk through during the initial visit. Client documents were received and reviewed to include the Physician’s Report, Individual Program Plan (IPP), client progress notes, and the Medication Administration Records (MARs).

During the investigation staff and the regional center coordinator stated that it is believed that the client has an appropriate placement with the facility. It was reported that sometimes the resident overestimates the assistance that he may need and does not always ask for assistance; however, overall is doing very well. It was reported that staff are available to assist the client as needed.

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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