502700646-12-31-2021-27-AS-KHOS-CAKUXL-20220111145830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700646
Report Date: 12/31/2021
Date Signed: 12/31/2021 03:41:47 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
09/13/2021 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20210913160005

FACILITY NAME:	CLAREMONT HOME		FACILITY NUMBER:	502700646
ADMINISTRATOR:	HUDDLESTON, DOLORES		FACILITY TYPE:	735
ADDRESS:	3324 CLAREMONT AVENUE		TELEPHONE:	(530) 515-9078
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	4	CENSUS: 3	DATE:	12/31/2021
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	D. Huddleston		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Staff denies access to the facility
Facility has inadequate food supplies
Individual in the home poses as a risk to the clients while in care
Individual yells at the clients while in care

INVESTIGATION FINDINGS:

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LPA A Johnson conducted a complaint visit to this facility regarding the above allegations. LPA spoke with Dolores Huddleston.

Staff denies access to the facility- Based on observation and interviews the Claremont staff confirmed that the garage door had a type of door handle that has a combination keypad and a conversation with Dolores confirmed that there is another refrigerator/freezer in the garage with surplus/overflow food supplies and toxins stored in the garage. Resident have access to fruits and snack in the kitchen and therefore do not need access to the area for snacks or food.

Facility has inadequate food supplies- LPA observed at Claremont on multiple visits conducted that there is more than an adequate supplies of both perishable and non-perishable foods for the three residents.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20210913160005

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: CLAREMONT HOME	FACILITY NUMBER: 502700646
	VISIT DATE: 12/31/2021

NARRATIVE

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Individual in the home poses as a risk to the clients while in care- Interviews conducted confirmed that Claremont home staff and Dolores (Administrator/licensee) both denied that staff Crystal would ever sleep over on the couch or in the extra bedroom at the home. They both also denied ever hearing Crystal talking on the phone about sexual content in front of other staff. Dolores confirmed that Claremont home is an awake night staff residence and that no one is allowed to sleep. She also confirmed that Crystal is no longer working at this facility, however, she is able to return to work.

Individual yells at the clients while in care- Dolores and Kathy denied anything about verbal abuse from any of the staff at the facility. Dolores stated that staff would be fired immediately if any resident was yelled at or spoken to with disrespect. Dolores confirmed that the facility has a zero tolerance policy for personal rights violations”. LPA attempted to interview residents at the facility, however, two residents are non-verbal and the other agrees with all question with "Yes".

The Department (CCLD) has found the allegations, Unsubstantiated. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

Exit interview was conducted with Licensee.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021

LIC9099 (FAS) - (06/04)

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