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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700754
Report Date: 06/22/2022
Date Signed: 06/24/2022 01:59:42 PM

Substantiated


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
03/15/2022 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220315160109
FACILITY NAME:DREAM CAREFACILITY NUMBER:
502700754
ADMINISTRATOR:HAWES, JULIANFACILITY TYPE:
735
ADDRESS:2004 KRUGER DRIVETELEPHONE:
(209) 661-4666
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:4CENSUS: 4DATE:
06/22/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Ednita GardenhireTIME COMPLETED:
01:13 PM
ALLEGATION(S):
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Staff made an inappropriate comment towards resident.
Staff are not properly trained.
INVESTIGATION FINDINGS:
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This report is being amended as a result of additional information and current documents recieved by the department from the facility on 6/8/2022.

Allegation: Staff made an inappropriate comment towards resident.

Based on interviews conducted the department discovered that staff are allegingly threatening R1 with potentially being homeless, if she continues to contact a former staff, it was also discovered during the investigation that R1 was told by a staff member that if she continues causing problems that she will not get her "Good Girl Money". Former staff and Resident confirmed that the term "Good Girl Money " was used on multiple occasions by staff to redirect R1 when she was not following her programming or intervention plan. During the visit on 5/13/2022, R1 asked the Administrator, "When do I get my Good Girl Money." The Administrator immediately corrected R1 and stated that "we don't use that term here." He then asked her " Who uses that term?" R1 replied, "You" referring to the
Administrator. The Administrator denied using the term and ask R1 "Did you hear that from a former staff?" R1 replied,"Yes". The behavior intervention plan for R1 was not current when this investigation was started. The plan reviewed at the time of the investigation was outdated. The department was able to obtain a current intervention plan dated 5/25/2022. Based on the current intervention plan the facility is to use a token reward system. This system requires points for R1's compliance which can be used to get gift cards, privileges and other identified items. There is no mention of money in the plan.

Allegation: Staff are not properly trained.

Based on records reviewed and interviews conducted the department has confirmed that S1 was working during the time of the complaint and was not trained in M1 MAB training, However she was trained in PRO-ACT/RC on 2/2022. On 6/8/2022, the department was able to obtain a current Behavior Intervention Plan for R1 dated 5/25/2022, The plan included a token reward system that did not include monetary compensation. Based on interviews with Staff and the Admininstrator, the facility was providing training to staff that included the use of Money as a reward for R1's good behavior, during the investigation it was also mentioned by staff and the administration that the facility uses a chart to track the progress of R1's behaviors. During the visits to the facillty on 3/7/22, 3/18/22, 3/22/22, 3/30/22 and 5/13/2022 LPA did not see a chart on the wall for R1's tracking. LPA was told by staff that the chart is not up because R1 will tear it down and they have not replaced it. The facility stated they keep track on a tracking sheet. The department has requested the a copy of the chart. The facility was unable to provide a chart for R1.

The department has re-investigated this complaint and determined it to be SUBSTANTIATED based on the current Behavior Plan and interviews.

Exit Interview
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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-20220315160109
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: DREAM CARE
FACILITY NUMBER: 502700754
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type B
06/30/2022
Section Cited
CCR
80072(a)(1)
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(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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The licensee shall have an inservice to complete a Patient Right's courses pertaining to both client rights and managing challenging client behaviors. The licensee shall also conduct a staff in-service pertaining to client rights.

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Interviews and witnessed conversation by S1 to Staff and Administrator, Former staff and Resident confirmed that the term "Good Girl Money " was used on multiple occasions by staff to redirect R1 when she was not following her programming or intervention plan.
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by POC date 6/30/2022
Request Denied: Appeal Not Submitted Timely
Type B
06/30/2022
Section Cited
CCR
85068.2(G)(1)
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(G) The licensee shall document the results of the initial assessment of the client, conducted pursuant to Health and Safety Code section 1180.4(a) prior to or on the day of admission.

1. The licensee shall document the initial assessment based on information available at the time of the assessment. This information shall be maintained and brought current thereafter as needed.
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The facility will provide an inservice to review all service plans for all residents in care by the POC date 6/30/22 and obtain current IPPs BIPs, ISPs
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This requirement was not met as evidenced by the outdated Intervention plan. The department was able to obtain a current intervention plan dated 5/25/2022 on 6/8/2022
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2