502700646-6-28-2023-27-AS-SRIN-CU3VAU-20230725161632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700646
Report Date: 06/28/2023
Date Signed: 06/28/2023 03:00:32 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
03/01/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230301113612

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: 4	DATE:	06/28/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Dolores Huddleston		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility kitchen is not kept clean
Proper staffing is not maintained

INVESTIGATION FINDINGS:

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LPA Jason Lund arrived unannounced to complete a complaint investigation. LPA met with Administrator Dolores Huddleston and explained the reason for the visit.
Facility kitchen is not kept clean- Based on records reviewed, observation, interviews with staff, witness, and clients. LPA Lund observed the facility kitchen to be clean and in good repair. LPA Lund observed no expired foods in the refrigerator nor the pantry. LPA interviewed facility staff who stated that part of their duties is to always keep the kitchen clean and to look for expired food. Keeping the kitchen clean includes the microwave, stove, refrigerator, floor and to take out the trash.
Based on facility records review, observation, interviews with staff, witness and clients, the information provided, it was unclear if the facility kitchen is not kept clean therefore the allegation was deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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-20230301113612

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: 06/28/2023

NARRATIVE

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Proper staffing is not maintained- Based on records review, observation, interviews with staff, witness and clients. The facility doesn’t have any clients who needs one on one care. There is no staffing ratio for the clients in care. The facility does use required hours from Valley Mountain Regional Center to maintain the proper staffing for the care of clients at the facility. LPA Lund reviewed staff timecards from November 28, 2023 through February 26, 2023 to ensure staffing at the facility. LPA Lund interviewed clients in care and stated that their needs are being taken care and enjoy living at the facility.

Based on facility records review, observation, interviews with staff, witness and clients, the information provided, it was unclear if proper staffing is not maintained the therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are 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 conducted and report left Administrator Dolores Huddleston

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC9099 (FAS) - (06/04)

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