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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000407
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:27:41 AM

Document Has Been Signed on 11/03/2022 11:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PRS - BAKER HOUSEFACILITY NUMBER:
525000407
ADMINISTRATOR:GATES, MARYFACILITY TYPE:
735
ADDRESS:14062 BAKER RDTELEPHONE:
(530) 529-9339
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 6CENSUS: 3DATE:
11/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Chase Puckett - administratorTIME COMPLETED:
12:00 PM
NARRATIVE
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11/03/2022 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a case management investigation. LPA met with administrator Chase Puckett and administrator Laurie Schlottman and explained the purpose of the visit. Prior to initiating the complaint investigation LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer when entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPA was screened by facility staff.

The reason for the visit is an incident report that was received on 10/17/2022, concerning an incident that occurred on 10/13/2022 in which it was reported that a staff person exchanged inappropriate text messages with a client.

On 10/13/2022 Client 1 (C1) reported to Staff 2 (S2) that they had been texting inappropriately with Staff 1 (S1). S2 reported this to the administrator. The administrator informed the human resources manager.

S1 was not due to be back on shift until the afternoon of 10/14/2022 at a different facility. On the afternoon of 10/14/2022 the administrator and HR Manager went to the other facility in the afternoon to talk to S1. S1 admitted that they had been texting inappropriately with C1. S1 showed the administrator and HR Manager their text messages that they hadn't responded to C1 on Thursday 10/13/2022, but had deleted their prior messages. S1 was removed from all Puckett Residential facilities and sent home.

Continued on LIC809-C

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: PRS - BAKER HOUSE
FACILITY NUMBER: 525000407
VISIT DATE: 11/03/2022
NARRATIVE
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The administrator and HR Manager talked to C1 and C1 stated that S1 had also been physically inappropriate with C1. C1 gave the administrator and HR Manager a detailed description of two separate incidents. C1 showed the administrator their phone and C1 had deleted all text messages between C1 and S1. The administrator notified Tehama County Sheriff and a deputy went to the facility to interview C1. The deputy requested that C1 go to the local hospital the next day for a SART (Suspected Abuse Response Team) Exam. The deputy interviewed C1 again on 10/15/2022 and asked C1 to go over the events again. The deputy told administrator Laurie Schlottman that he would be contacting S1.

In a related SOC341 form that was submitted by the administrator the administrator states the HR manager and the administrator interviewed S1 at 4:00 PM on 10/14/2022 and asked S1 if they had been inappropriately communicating with C1. The report states that S1 admitted they had sent and received text messages with C1 which were inappropriate. The date and time of the incident was reported from 10/05/2022 and ongoing.


The following deficiency was observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties.

An exit interview was conducted, and a copy of the report and appeal rights were emailed to administrator Chase Puckett.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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Document Has Been Signed on 11/03/2022 11:27 AM - It Cannot Be Edited


Created By: Rebecca Knight On 11/03/2022 at 09:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PRS - BAKER HOUSE
FACILITY NUMBER: 525000407

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2022
Section Cited
CCR
80072(a)

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80072(a) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (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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Administrator agrees to complete personal rights training with all staff specific to the personal rights for clients to be accorded dignity in their personal relationships with staff. Administrator agrees to provide a signed and dated staff attendance sheet to LPA as proof of correction.
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Based on LPA interviews and document review it was determined that Staff 1 exchanged inappropriate text messages with Client 1 which poses a potential health and safety risk to residents in care.
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The proof of correction is to be received by LPA Knight by 11/17/2022.

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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.
SUPERVISOR'S NAME:Troy Ordonez
LICENSING EVALUATOR NAME:Rebecca Knight
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


LIC809 (FAS) - (06/04)
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