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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 557001183
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:00:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
04/11/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240411154031
FACILITY NAME:VALLEY OAKS FAMILY HOMEFACILITY NUMBER:
557001183
ADMINISTRATOR:MONA B. GASKILLFACILITY TYPE:
735
ADDRESS:16649 ANDERSON ROADTELEPHONE:
(209) 928-1196
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:8CENSUS: 7DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Mona GaskillTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident sustained a fracture while in care.
Staff did not seek timely medical treatment for resident.
Staff goes through resident(s) personal belongings.
INVESTIGATION FINDINGS:
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On 8/8/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with Licensee Mona Gaskill and explained the purpose of today's visit.

During the course of this investigation LPA Jensen conducted client interviews, staff interviews, reviewed records and inspected the physical plant.

Allegation 1: Resident sustained a fracture while in care
LPA Jensen conducted interviews and reviewed records. It has been confirmed that residents have sustained a fracture(s) while in care however residents confirm staff were available and attended to the issue appropriately. Staff's accounting of the incident was consistent with the resident's account of the incident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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-20240411154031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: VALLEY OAKS FAMILY HOME
FACILITY NUMBER: 557001183
VISIT DATE: 08/08/2024
NARRATIVE
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 Based on the interviews conducted and records reviewed the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it.

Allegation 2: Staff did not seek timely medical treatment for resident.
LPA Jensen interviewed staff who all stated that they call 911 if a resident sustains an injury that warrants receiving medical treatment or even if it is questionable whether they need medical treatment. After calling for medical attention they then notify the Licensee. LPA Jensen reviewed resident files and found no evidence of delayed medical treatment. LPA Jensen interviewed residents who all confirmed staff assist them in obtaining timely medical treatment when needed. Based on the interviews conducted and records reviewed the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it.

Allegation 3: Staff goes through resident(s) personal belongings.
LPA Jensen interviewed staff and residents. The staff members interviewed stated they are not permitted to go through client items. The residents interviewed denied having any knowledge of staff going through there belongings. Based on the interviews conducted with staff and clients the allegation UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it.

No deficiencies were cited as a result of this visit. An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2