486800152-4-27-2023-21-AS-CMAZ-CRQLVP-20230511090552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486800152
Report Date: 04/27/2023
Date Signed: 04/27/2023 02:35:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230118110258

FACILITY NAME:	GRACE CARE HOMES		FACILITY NUMBER:	486800152
ADMINISTRATOR:	PATTON, ALEXIS W.		FACILITY TYPE:	735
ADDRESS:	362 WINCHESTER STREET		TELEPHONE:	(707) 246-6826
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	6	CENSUS: 4	DATE:	04/27/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Alexis Patton, Licensee		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident sustained injuries due to staff handling him in a rough manner
Staff hit resident
Staff yells at residents

INVESTIGATION FINDINGS:

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On 4/27/2023 Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint and was greeted by Staff, Anotnio Madden. Licensee, Alexis Patton arrived later in the visit. During the course of the investigation LPA toured the facility, interviewed staff and clients, reviewed records and made observations.

Complaint alleges resident sustained injuries to C3's finger and body due to staff handling him in a rough manner. Based on interviews with staff and clients (C1 & C2) there have been no observed incidents in which clients were handled in a rough manner causing injury. Based on a review of medical records, client (C3) had been admitted to the ER after being diagnosed with cellulitis on C3's right hand/finger with no indications observed by staff and other clients of staff causing injury to C3. Based on a review of C3's Individual Program Plan it is indicated that C3 has a history of self-injurious behaviors including hitting head, other body parts and throwing body on objects/surroundings and history of slamming hands on tables/surfaces.

Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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 21-AS-20230118110258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: GRACE CARE HOMES	FACILITY NUMBER: 486800152
	VISIT DATE: 04/27/2023

NARRATIVE

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Complaint alleges staff hit resident. Co-Complainant reported to have observed staff S4 hit residents while providing care. LPA interviewed staff (S1 & S3) who both indicated that they have not observed S4 or any other staff strike or physically mistreat clients in care. LPA interviewed clients (C1 & C2) who both found to be comfortable with staff and Licensee presence. C1 and C2 both stated that they have not experienced staff hitting them. In addition, C1 and C2 have not observed staff physically mistreating other residents. Based on contradicting statements from various staff and client parties, the allegation is found to be unsubstantiated.

Complaint alleges staff yells at residents. Co-Complainant reported to have observed staff S4 yell at residents while providing care. LPA interviewed staff (S1 & S3) who both indicated that they have not observed S4 or any other staff yells or verbally mistreat clients in care. Staff stated that clients are spoken to in a stern manner when staff re-direct or coach clients but not in an inappropriate manner. LPA interviewed clients (C1 & C2) who were both observed to have positive relationships with staff and Licensee. C1 and C2 both stated that they have not experienced staff yelling, teasing or speaking inappropriately towards them. C1 stated that staff do speak with them in a louder tone but not in a mean or inappropriate manner for guidance on behaviors. Based on contradicting statements from various staff and client parties, the allegation is found to be unsubstantiated.

Allegation, resident sustained injuries due to staff handling him in a rough manner, staff hit residents and staff yell at residents are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Appeal Rights given.

No deficiencies cited.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

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