486803851-12-7-2023-21-AS-VBEI-CYJ2YD-20231214164834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803851
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:43:19 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
09/05/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20230905121421

FACILITY NAME:	TELECARE BECK LANE		FACILITY NUMBER:	486803851
ADMINISTRATOR:	JENNINGS, MONTEL		FACILITY TYPE:	738
ADDRESS:	4500 BECK LANE		TELEPHONE:	(707) 299-9041
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95688
CAPACITY:	4	CENSUS: 3	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Montel Jennings, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff prevented client from leaving his room
Facility staff withheld food from client

INVESTIGATION FINDINGS:

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On 12/7/2023, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings. LPA toured the facility, reviewed facility records, made observations and interviewed staff and outside parties during the course of the investigation.

Complaint alleges facility staff prevented client (C1) from leaving his room. Photos of facility disrepair were provided indicating client C1's bedroom door appearing to be without a door knob. Based on observation, and review of service repair records, C1’s bedroom doorknob was noted for repair and had been repaired since the initial damage in December 2022. Upon interviews with multiple staff and North Bay Regional Center Service Coordinators (SC1 & SC2), there is no clear indication or observation that C1 was locked in or prevented from leaving their bedroom. SC2 also stated that they were notified of the bedroom doorknob in need of repair and indicated that it was resolved in a timely manner. Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated.
Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20230905121421

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: TELECARE BECK LANE	FACILITY NUMBER: 486803851
	VISIT DATE: 12/07/2023

NARRATIVE

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Complaint alleges facility withheld food from client C1 causing significant weight loss. Based on a review of C1’s records, the only indication of dietary measures called for gluten-free diet. LPA toured the facility kitchen and dining area during multiple visits and found an ample amount of food and snack options for clients in care. Food was not found to be locked or inaccessible to clients. In addition, upon interviews with North Bay Regional Center Service Coordinators (SC1 & SC2), it was stated that during several visits to the facility, C1 was seen to have access to an ample amount of food and snack supplies in the primary facility building. SC1 stated that they observed C1 on several occasions acquiring food from the kitchen and taking the food items back to their room. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated.

Allegations, staff prevented client from leaving his room and facility withheld food from client are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies cited. Appeal rights given.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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