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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002731
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:13:51 PM

Substantiated


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
11/19/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20241119094457
FACILITY NAME:IPS- VINSON DRIVEFACILITY NUMBER:
455002731
ADMINISTRATOR:KNIGHT, JOSHUAFACILITY TYPE:
735
ADDRESS:1786 VINSON DRIVETELEPHONE:
(530) 605-3755
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:4CENSUS: 4DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Residential Care Coordinator, Amanda ZumkehrTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility failed to ensure that client received timely medical attention.
INVESTIGATION FINDINGS:
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On December 12, 2024 at approximately 2:00 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at IPS-Vinson for the purpose of delivering complaint findings. LPA was granted access into the facility. LPA met with Residential Care Coordinator, Amanda Zumkehr.

During the course of the investigation, LPA Sarangi interviewed staff members, a client and witnesses. In addition, LPA reviewed the client file which included the discharge paperwork from the medical provider, admission agreement and termination document for the former Administrator.

Complaint alleges that facility failed to ensure that client received timely medical attention. Based on interviews that were conducted, the preponderance of evidence standard has been met. LPA conducted interviews with staff and witnesses which confirmed that the former administrator did not seek medical attention in a timely manner (See LIC9099D). During an email exchange with the HR Administrator of the (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20241119094457
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- VINSON DRIVE
FACILITY NUMBER: 455002731
VISIT DATE: 12/12/2024
NARRATIVE
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facility dated for November 27, 2024, LPA learned that the former facility administrator did not address the situation appropriately and as outlined in Title 22 regulation. During a review of the discharge paperwork, LPA learned that the foot cast was on for approximately six weeks. Furthermore, LPA reviewed the Termination Documents provided by the facility which reflected that the former administrator was terminated due to violating multiple company policies. LPA educated the current administrator on the importance of ensuring that timely medical attention is afforded to ALL clients in care.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6, Chapter 1 of California Regulation. Appeal rights were provided. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the Residential Care Coordinator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20241119094457
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- VINSON DRIVE
FACILITY NUMBER: 455002731
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2024
Section Cited
CCR
80075(a)
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80075(a) Health Related Services:

(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.

This requirement was met as evidenced by:
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Licensee/Administrator shall complete an LIC 9098-Self Certification form. In addition, the Licensee/Administrator shall conduct training to ALL staff who provide care and supervision to clients in care. Licensee/Administrator shall provide a statement on how future compliance will be met.
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Based on interviews that were conducted and documents reviewed, the former administrator of the facility did not seek timely medical attention which presents an immediate health, safety, and personal rights risk to the client(s) in care.
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POC due date December 19, 2024
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3