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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700117
Report Date: 04/17/2023
Date Signed: 04/17/2023 12:41:56 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20221004093250
FACILITY NAME:STEPS HOMEFACILITY NUMBER:
502700117
ADMINISTRATOR:VICTOR MANUEL CARDONAFACILITY TYPE:
735
ADDRESS:560 ASHLAND AVENUETELEPHONE:
(415) 652-6720
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:5CENSUS: 4DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Victor CardonaTIME COMPLETED:
11:59 AM
ALLEGATION(S):
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Staff allegedly physical altercation with client
INVESTIGATION FINDINGS:
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On 4/17/23 at approximately 11:20am Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to continue an investigation in to the above listed allegation. LPA Jensen met with Licensee Victor Cardona and explained the purpose of todays visit.

LPA Jensen interviewed Staff 1 (S1). S1 denies witnessing any physical altercations between staff and Resident 1 (R1) and has no knowledge of any abuse, physical or verbal, by staff to residents.

LPA Jensen interviewed Resident 2 (R2). R2 recalls the resident in question and denies witnessing any physical altercations between staff and R1 and has no knowledge of any abuse, physical or verbal, by staff to residents.

Continued on LIC 9099C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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 27-AS-20221004093250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: STEPS HOME
FACILITY NUMBER: 502700117
VISIT DATE: 04/17/2023
NARRATIVE
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Records Review
During the course of the investigation LPA Jensen also reviewed the Police Report # TP22006373. Turlock Police Department conducted an investigation in to the above listed allegation that consisted of a visit to the scene and interviews with Resident 1's (R1), R1's responsible party, the Licensee and Staff 2 (S2).
Due to conflicting statements, the Police Department was unable to substantiate the allegations.

LPA Jensen reviewed a written statement in which S2 describes an incident with R1 during which R1 became aggressive and engaged in self injurious behaviors resulting in a black eye to himself.

LPA Jensen interviewed the Licensee who also stated that R1 became aggressive on 9/30/22 and engaged in self injurious behaviors resulting in a black eye to himself.

LPA Jensen reviewed R1's Individual Program Plan, Regional Center Progress reviews, Regional Center Behavior Summary reports and incident reports. The records reviewed affirm that R1 has a history of self injurious behavior.

Based on the conflicting statements given by interviewees and the documentation reviewed, the allegation of staff having a physical altercation with R1 is UNSUBSTANTIATED. A finding of unsubstantiated means although the allegation may have happened, the preponderance of evidence does not prove it.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2