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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803851
Report Date: 07/13/2023
Date Signed: 07/13/2023 11:13:24 AM

Document Has Been Signed on 07/13/2023 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LANEFACILITY NUMBER:
486803851
ADMINISTRATOR:JENNINGS, MONTELFACILITY TYPE:
738
ADDRESS:4500 BECK LANETELEPHONE:
(707) 299-9041
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 4CENSUS: 4DATE:
07/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Montel JenningsTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Farhaan Sarangi and Carol Fowler arrived unannounced at Telecare Beck Lane for the purpose conducting a Case Management-Incident Inspection. LPA was greeted outside by Administrator, Montel Jennings and was granted access into the facility. LPAs are following up on Incident Reports that were forwarded to the Regional Office on June 22, 2023.

During the Case Management-Incident Inspection, LPA toured the facility and found the facility undergoing alteration to the inside. Administrator shared that the Regional Center approved of these alterations and the expected completion date will be by July 14, 2023. Department of Developmental Services (DDS) was notified of this. LPA educated Administrator regarding the importance of providing Licensing with notification even though it is a minor alteration (See LIC 9102-Technical Assistance).

LPA learned that there was a change in medication regarding Client #1. LPA reviewed the Individual Behavioral Support Plan (IBSP) and observed that client is on a 1.5 to 1 ratio. During the incident in question, client was properly being supervised during that time. Client had an escalation of behavior and attacking staff which resulted in Client #1 being arrested. Client is currently at home right now and is not available for an interview at this time. Upon return to the facility; the family, the facility and the Regional Center will have a discussion regarding updating the medications and/or providing additional resources to the family. In addition, Care Plan will be updated with consultation from the Regional Center, the family and the Primary Care Physician.

No deficiencies were observed or cited during today's Case Management-Incident inspection. Exit interview was conducted and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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