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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700646
Report Date: 05/23/2022
Date Signed: 05/23/2022 05:03:20 PM

Document Has Been Signed on 05/23/2022 05:03 PM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CLAREMONT HOMEFACILITY NUMBER:
502700646
ADMINISTRATOR:HUDDLESTON, DOLORESFACILITY TYPE:
735
ADDRESS:3324 CLAREMONT AVENUETELEPHONE:
(530) 515-9078
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 4CENSUS: 3DATE:
05/23/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Dolores HuddlestonTIME COMPLETED:
12:45 PM
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On May 23. 2022 an office meeting was held regarding the Hudson Home (507004129) the Small Family home licensed to Licensee Dolores Huddleston. Present at the meeting was: Regional Manager, Nelson Martinez; Licensing Program Manager, Juanita Arroyo; and Licensing Program Analysts, Cynthia Galindo and Rachel Bruce. The meeting was with Administrator/ Licensee, Dolores Huddleston of Hudson Home (507004129). Dolores Huddleston is also the Licensee for Claremont Home (502700646) with Adult & Senior Care of Sacrament South.
On the meeting via teleconference were representatives from Valley Mountain Regional Center, Rukaiyah Jones and Katina Richison; Stanislaus County social workers, Isabel Ramirez-Jimenez and
Shakena Graves; San Joaquin county social worker Pedro Rodriguez; and Sacramento South Adult and Senior Care LPM Stephanie Doub and Acting Regional Manager Czarrina Camilon-Lee and LPA Jason Lund.

This Noncompliance Conference was called by Children’s Residential programto discuss the following issues or deficiencies at Hudson Home:
Agency was licensed July 11, 2008. Since that date there have been 25 complaints lodged against the Hudson Home (507004129), This is a children home.

Review of the recent complaint findings that are Substantiated (2022) are as follows:

Care and Supervision Regulations -1:1 staff ratio not being met:

Covid Quarantine protocols not being followed.
Cont...
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CLAREMONT HOME
FACILITY NUMBER: 502700646
VISIT DATE: 05/23/2022
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Lack of Staff training and deficiencies cited in the following areas:

Cultural Competency/ Personal Rights / Food Preparation/ Medication

Documentation- Record Keeping- Staff schedules / hours worked

Licensee Duties: - Administrator not living on premises.

The above substantiated concerns and findings are serious and negatively impact the quality of care provided to
the clients.

An appeal. regarding substantiated complaints was received by CCL on May 16, 2022. It is currently under review. Discussion was held regarding appeal process. Reports will be amended if findings are to change.

The goal of this meeting was to get the facility back in compliance and to address any concerns or questions related to that endeavor.

Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:

Increased unannounced and announced facility inspections will be conducted by CCL.

Staff files need to be available even if Licensee is not present.

Administrator will ensure proper training of staff is provided on a regular and consistent basis. Documentation of said training must be available upon request and documented in individual staff files.

Cont....
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CLAREMONT HOME
FACILITY NUMBER: 502700646
VISIT DATE: 05/23/2022
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Administrator will provide quarterly in person training with staff (minimum of 4 hours). Topics will include but not be limited to. Care and Supervision- expectations of staff; Personal Rights- cultural competency- Appropriate
discipline; Medication- dispensing and documentation protocol.

Administrator must be readily available to support staff and residents.

Administrator to maintain documentation regarding staff schedules to document 1:1 support and staff ratios.

Administrator will increase staff ratio to meet the needs and services of the clients. Any changes will be documented in a timely manner and submitted to CCL on LiC 500. Starting June 5, 2022 Licensee will be required to submit updated information on a monthly basis.

Activity calendar- to be drafted/ followed and documentation maintained.

Administrator to update program statement: The following sections shall be updated and submitted to CCL by June 30, 2022:

Mandating reporting, personal rights, training (cultural competency) discipline policy and token system.

Administrator to consider utilizing the Technical Support Program referral which is voluntary. Administrator is in agreement with this offer and would like the assistance.

Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking the following action(s):

Facility is notified that a Licensing program Analyst will be conducting additional monitoring of the facilities to ensure the compliance of the facility has increased and maintained at Departmental standards.
Cont...


SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CLAREMONT HOME
FACILITY NUMBER: 502700646
VISIT DATE: 05/23/2022
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The informal conference process was explained during this meeting. The licensee was advise that failure to bring the facility into compliance may lead to administrative action by the Department. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Licensee Dolores Huddleston via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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