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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496830785
Report Date: 02/06/2024
Date Signed: 02/06/2024 10:26:05 AM

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
01/10/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240110144925
FACILITY NAME:M3 DAY PROGRAMFACILITY NUMBER:
496830785
ADMINISTRATOR:CLEIN GALANG, MARYFACILITY TYPE:
775
ADDRESS:1360 NORTH DUTTON AVETELEPHONE:
(650) 866-9367
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:30CENSUS: 30DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary Clein (Administrator)TIME COMPLETED:
10:40 AM
ALLEGATION(S):
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-Staff yell at Clients.
-Clients hygiene needs are not being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Cuadra (LPA) arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Administrator Mary Galang.

The Department received an allegation of staff yelling at clients. Per Reporting Party clients were observed being treated rudely, there were no further details provided. During investigation LPA conducted a 10-day complaint visit on January 16, 2024, reviewed records, made observations at the facility and conducted interviews with staff and participants. Based on interviews conducted by LPA with staff and participants no information was provided that any staff is yelling at participants in care. The complainant did not provide any participant’s name that were observed being treated rudely by staff. No information of any yelling other than some participants whose usual behavior is to speak loudly when they attend to day program.

Continues on LIC9099C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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-20240110144925
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: M3 DAY PROGRAM
FACILITY NUMBER: 496830785
VISIT DATE: 02/06/2024
NARRATIVE
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Continued from LIC9099...

The above allegation could not be determined based on interviews and information provided during investigation. A finding that the complaint allegation of staff yelling at clients is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Another allegation received is regarding clients’ hygiene needs are not being met. The anonymous complainant reported that clients have not been changed. However, the complainant did not provide any name of a specific participant. During LPA’s 10-day complaint visit conducted on January 16, 2024, LPA observed ten staff including two trainee direct support staff (DSP), one nurse and one activity coordinator to assist participants with their needs. Based on records review, the facility provided a daily progress flowsheet that includes mental status, meal intake, activities of the day options, nursing notes, particular notes, restroom use bladder and bowel movement times, which it had a space for morning and afternoon check. The daily progress flowsheet is developed into a daily clinical report for the facility records. LPA was provided with daily clinical reports for the month of January 2024, where it does indicate that participants have been assisted with their daily care needs. Based on interviews conducted with eight participants (P1, P2, P3, P4, P5, P6, P7 & P8) and six staff (S1, S2, S3, S4, S5 & S6) confirmed that staff are assisting participants with their hygiene care needs. LPA was unable to gather additional information with an anonymous complainant because their contact information was not provided. A finding that the complaint allegation of clients’ hygiene needs are not being met is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2