525000804-8-22-2023-59-AS-LCRR-CV6RHJ-20230829130222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525000804
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:19:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2023 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 59-AS-20230621090445

FACILITY NAME:	NORTH VALLEY SERVICES - BEHAVIOR MANAGEMENT PGRM		FACILITY NUMBER:	525000804
ADMINISTRATOR:	CHAVEZ, ESPERANZA		FACILITY TYPE:	775
ADDRESS:	13315 BAKER RD		TELEPHONE:	(530) 528-1083
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	80	CENSUS:	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Esperanza Chavez - administrator		TIME COMPLETED:	12:15 PM

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Day program did not follow client's needs and services plan. - UNSUBSTANTIATED

INVESTIGATION FINDINGS:

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08/22/2023 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Esperanza Chavez. The purpose of this visit was to deliver the results of a complaint investigation.

During the course of the investigation the day program supervisor and 4 staff were interviewed.

The following documents were received and reviewed: staff list with telephone numbers, Physician’s report, Admission Agreement, Individual Services Plan, IPP for 1 Client.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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 59-AS-20230621090445

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: NORTH VALLEY SERVICES - BEHAVIOR MANAGEMENT PGRM	FACILITY NUMBER: 525000804
	VISIT DATE: 08/22/2023

NARRATIVE

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Day program did not follow client's needs and services plan. – UNSUBSTANTIATED

It was alleged that the day program did not follow a client’s needs and services plan (Individual Services Plan) when they took Client 1 (C1) to a water park even though C1 has known maladaptive behaviors which could be triggered in this environment.

LPA review of C1’s Individual Services Plan revealed that C1 has an inappropriate obsession over young girls and/or women. At baseline C1 requires staff interaction or direction 100% of the time to ensure the public is safe from C1’s behavior. The current objective for C1 is while at home or in public, C1 will be able to be redirected with verbal or gestural cues 2 out of 5 times. Interventional strategies are redirection, pointed reinforcement, cancelation of outing or activity. The reinforcement plan is that staff will be able to allow C1 more personal space and choice on outings or activities. C1 will be socially accepted by the public and C1’s peers and will be able to interact without behaviors with the members of the community and C1’s home.

4 of 5 staff stated that during the outing in question the environment was set up so that C1 was not around children. 1 staff stated C1 was sitting with staff the whole time. 4 of 4 staff stated the environment was set up so C1 was safe. 4 of 4 staff stated they followed C1’s Individual Service plan as directed.

It was determined that even though the day program took C1 on an outing to a water park which could potentially trigger their known maladaptive behaviors the day program followed C1’s Individual Service Plan which includes staff interaction and redirection to keep C1 and the public safe while allowing C1 their choice of outings and activities. This allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to administrator Esperanza Chavez.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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