486803851-12-7-2023-21-AS-VBEI-CYVQ2L-20231226104715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803851
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:45:48 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
10/27/2023 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 21-AS-20231027104514

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:	03:16 PM
MET WITH:	Montel Jennings, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not safeguard resident’s personal belongings

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, made observations, and interviewed staff and outside parties during the course of the investigation.

Complaint alleges facility staff did not safeguard resident’s (C1) personal belongings. The reporting party indicated that C1 had several personal items including a bed frame, electronics and clothing missing or not returned to C1 upon discharge from the facility. Upon tour of the facility LPA observed bedframe and mattress in a vacant room where client C1 previously resided. LPA interviewed Administrator, Montel Jennings (AD) who stated that the facility allowed C1 to claim their belongings including C1’s bed. However, C1’s family was unable to pickup/store the items resulting in the items being left at the facility. Based on interview with the Reporting Party it was confirmed the same information was consistent with the Administrator’s statement on C1's items being available for retrieval.

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-20231027104514

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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In addition, upon interviews with North Bay Regional Center Service Coordinators (SC1 & SC2), it was stated that C1 had a history of destructive behaviors to both property and personal items including electronic devices. Lastly, SC1 also indicated that client C1 had misplaced a jacket while attending school but was unable to locate the item. Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated.

Allegations, facility staff did not safeguard resident’s (C1) personal belongings is 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 violation 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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