455002730-2-27-2024-59-AS-KHOS-D39HSJ-20240311062714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002730
Report Date: 02/26/2024
Date Signed: 02/27/2024 09:05:53 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
01/03/2024 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20240103134221

FACILITY NAME:	IPS- PICKFORD WAY		FACILITY NUMBER:	455002730
ADMINISTRATOR:	GARDNER, BONNIE		FACILITY TYPE:	735
ADDRESS:	20374 PICKFORD WAY		TELEPHONE:	(530) 605-3605
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	4	CENSUS: 3	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	STEPHEN WILLIS		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff physically abused a resident in care.
Staff did not treat a resident with dignity.

INVESTIGATION FINDINGS:

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On 02/27/24, Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 01/03/24. LPA Gurriere met with Stephen Willis, Administrator, and explained the purpose of the visit.

Staff physically abused a resident in care.

During the interview process, the administrator, five staff persons and one resident (Resident 1) were interviewed. Documents pertaining to the resident were collected and reviewed to include the resident’s Individual Program Plan, medications list, incident reports, and facility report log of incidents.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20240103134221

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: IPS- PICKFORD WAY	FACILITY NUMBER: 455002730
	VISIT DATE: 02/26/2024

NARRATIVE

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During the investigation, it was reported that a staff person was abusive by playing loud music while the resident slept, and an accusation was made that a staff person pushed the resident down. Staff were interviewed and overall, it was reported that staff were not aware that a staff person was abusive by playing loud music and staff were not aware of the resident being physically abused. Some staff indicated that the resident retracted her allegation after she made it.

Staff did not treat a resident with dignity.

During the interview process, the administrator, five staff persons and one resident (Resident 1) were interviewed. Documents pertaining to the resident were collected and reviewed to include the resident’s Individual Program Plan, medications list, incident reports, and facility report log of incidents.

During the investigation if was reported that during a behavioral incident, Resident 1 spit in the face of two staff persons. There were witnesses to the altercation and it was reported that the resident did spit; however, the staff persons did not spit back. During the interview process, the resident retracted her statement and advised that the staff did not spit back.

Although the above allegations mentioned may have happened, or is 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: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

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