455002729-9-12-2024-59-AS-KHOS-D9DPQZ-20240923113158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002729
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:00:10 PM

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
05/15/2024 and conducted by Evaluator Ivan Avila

COMPLAINT CONTROL NUMBER: 59-AS-20240515112006

FACILITY NAME:	CLOVER		FACILITY NUMBER:	455002729
ADMINISTRATOR:	SCHWARTZ, HEATHER		FACILITY TYPE:	735
ADDRESS:	19625 CLOVER ROAD		TELEPHONE:	(530) 782-2572
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	4	CENSUS: 4	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Nathan Sawyer		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff did not meet a client's medical needs while in care
Staff did not have planned activities for a client
Staff unlawfully evicted a client
Staff did not prevent a client from bothering another client

INVESTIGATION FINDINGS:

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On 09/12/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegations directed by the Department. LPA met with Nathan Sawyer and explained the purpose of the visit.

During the investigation process, interviews and a records review was initiated.

LPA investigated the allegation, “Staff did not meet a client’s medical needs while in care.” Based on record review and interviews conducted, staff had taken C1 to multiple doctor’s appointments when necessary. Facility had offered C1 therapy sessions but C1 declined them each time a session was mentioned. C1 refused to participate in therapy.

-------Continued on LIC9099C-------

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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-20240515112006

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: CLOVER	FACILITY NUMBER: 455002729
	VISIT DATE: 09/12/2024

NARRATIVE

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LPA investigated the allegation, “Staff did not have planned activities for a client.” Based on record review and interviews conducted, C1 was offered multiple outings a week. C1 did not want to participate in the outings involving other clients. Staff would take C1 independently to the gym and to the local store where he would spend multiple hours for each outing. C1 had multiple weekly outings a week with staff. LPA reviewed C1s weekly outing logs, and it was observed C1 was involved in activities.

LPA investigated the allegation, “Staff unlawfully evicted a client.” Based on record review and interviews conducted, C1 had expressed to staff he did not want to live at the facility. The facility planned to find him an independent living arrangement but C1 did not want to wait and signed himself out of the facility and no longer wanted services provided by the facility. C1 left by his own choosing and did not want to wait for new placement. Staff were still able to assist C1 with doctor’s appointments while C1 was no longer living at the facility.

LPA investigated the allegation, “Staff did not prevent a client from bothering another client.” Based on interviews conducted, staff stated they would redirect C1 and another client from coming in contact with each other due to C1s dislike of C2. C1 did not like the sound of C2s voice and comments C2 made to other staff. Staff redirected C1 by asking him to write down his frustrations in a journal to express himself. Staff said C1 would be the one to seek out C2, but staff would interject and suggest alternatives for C1 not to get upset at other clients.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, a copy of the report and appeal rights was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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