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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002926
Report Date: 02/24/2025
Date Signed: 02/24/2025 11:49:06 AM

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
02/18/2025 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20250218153233
FACILITY NAME:CHARADE HOMEFACILITY NUMBER:
455002926
ADMINISTRATOR:MONTGOMERY, YVETTE L.FACILITY TYPE:
735
ADDRESS:1943 CHARADE WAYTELEPHONE:
(530) 515-8314
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:4CENSUS: 3DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator, Crystal MonismithTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff violated client personal rights
INVESTIGATION FINDINGS:
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On February 24, 2025 at approximately 11:30 AM, Licensing Program Analysts (LPAs), Farhaan Sarangi and Kayla Adkison arrived unannounced at Charade Home for the purpose of conducting a tour of the facility and delivering complaint findings. LPAs were greeted at the door by Administrator, Crystal Monismith, and was granted access into the facility.

During the course of the investigation, LPAs conducted Collateral Interviews with clients in care, a former staff member and witnesses from an outside agency. In addition, LPA Sarangi reviewed Client #1’s records and the former staff member’s file. LPAs conducted a tour of the facility on February 24, 2025, and made observations.

Complaint alleges that Staff violated client personal rights. Based on interviews that were conducted and an observation of the former staff members file, the preponderance of evidence standard has been met. During interviews with the outside agency Witness #1 and Witness #2, (Report continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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-20250218153233
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: CHARADE HOME
FACILITY NUMBER: 455002926
VISIT DATE: 02/24/2025
NARRATIVE
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LPA learned that the former staff member spoke inappropriately to the client in care by using foul language. During Collateral Interviews, 3 out of 3 clients in care confirmed the details of the incident in question which corroborated the interviews with Witness #1 and Witness #2 (See LIC 9099D). On February 20, 2025, LPA reviewed the former staff members file and learned that the former staff member was terminated due to the incident in question. LPA educated the Administrator on the importance of ensuring that Personal Rights are 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 Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250218153233
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: CHARADE HOME
FACILITY NUMBER: 455002926
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/05/2025
Section Cited
CCR
80072(a)(3)
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80072(a)(3) Personal Rights:

(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature….

This requirement was not met as evidenced by:
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Licensee shall submit an LIC 9098 understanding of the regulation. Furthermore, Licensee shall conduct staff training on Personal Rights and provide a statement on how future compliance will be met.
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Based on interviews that were conducted with the outside agency Witness #1, Witness #2 and all clients in care, the former staff member spoke inappropriately to the client in care by using foul language which presents an immediate health, safety, and personal rights risk to the client(s) in care.
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POC due date: March 5, 2025.
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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: 02/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3