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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803874
Report Date: 01/17/2024
Date Signed: 01/17/2024 03:22:29 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
10/12/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20231012083347
FACILITY NAME:TELECARE ENGLISH HILLSFACILITY NUMBER:
486803874
ADMINISTRATOR:OLIVES, ADAM J.FACILITY TYPE:
738
ADDRESS:7821 ENGLISH HILLS ROADTELEPHONE:
(707) 815-2511
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY:4CENSUS: 3DATE:
01/17/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Heidi Noriesta, LVN & Abby Carvajal, Acting AdministratorTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff unable to assist resident(s) in a timely manner
INVESTIGATION FINDINGS:
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On 1/17/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by LVN, Heidi Noriesta and Acting Administrator, Abby Carvaja LPA toured the facility, reviewed facility and client records, interviewed staff and outside parties and made observations.

Complaint alleges staff are unable to assist resident(s) in a timely manner due to staffing and client (C1) needs. Based on a review of client and facility records as well as interviews with Regional Director of Operations , Tiffany Speiker (S1) and North Bay Regional Center Service Coordinator (SC1) it was found that staffing expectations for client care is between 4-5 staff present during morning and afternoon shifts with client (C1) at a 2:1 ratio. LPA conducted a review of staff timesheets for October 2023 for dates pertaining to incident reports for C1 and was unable to determine staff shortages. During multiple visits to the facility, LPA observed a sufficient amount of staff present for clients in care.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
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 2
Control Number 21-AS-20231012083347
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 ENGLISH HILLS
FACILITY NUMBER: 486803874
VISIT DATE: 01/17/2024
NARRATIVE
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 In addition, upon interview with S1 it was indicated that the facility was in partnership with Northbay Regional Center for staffing support when needed. Lastly, upon interview with SC1, it was stated that they serve as the liaison for all three clients and indicated no issues with staffing shortages or meeting these expectations.

Allegation, staff unable to assist resident(s) in a timely manner 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 during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2