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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 557004883
Report Date: 04/11/2024
Date Signed: 04/11/2024 11:57:43 AM

Substantiated


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
03/14/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240314165749
FACILITY NAME:WATCHFACILITY NUMBER:
557004883
ADMINISTRATOR:CLINT BOWERFACILITY TYPE:
775
ADDRESS:12801 CABEZUT ROADTELEPHONE:
(209) 533-0510
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:140CENSUS: 72DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Clint BowersTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff spoke inappropriately to client in care
INVESTIGATION FINDINGS:
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On 4/11/24 at approximately 10:10 am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced for a complaint investigation related to the above listed allegations. LPA Jensen met with Executive Director Clint Bowers and explained the purpose of today's visit.

During the course of the investigation LPA Jensen conducted interviews with 9 staff members in various positions including administrative staff, management, instructors and human resources. LPA Jensen also interviewed 2 Day Program clients and 1 Regional Center Service Coordinator. Records reviewed include client Individual Program Plan and facility staff observation reports. The investigation revealed that a day program client (C1) felt staff was treating them unfairly. Multiple staff members stated that C1 had either been suspended or asked not to attend Program for a preiod of time for a perceived theft of an item in the lost and found. 2 staff members stated they witnessed another staff member speak to C1 in a manner that could be percieved as inappropriate.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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 3
Control Number 27-AS-20240314165749
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: WATCH
FACILITY NUMBER: 557004883
VISIT DATE: 04/11/2024
NARRATIVE
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LPA Jensen also reviewed findings related to an independent investigation conducted by Valley Mountain Regional Center wherein it was substantiated that a personal rights violation occurred.

Based on multiple staff members confirming that C1 was excluded from program and 2 staff members alleging that C1 was spoken to in a manner that could be perceived as inappropriate, the allegation of "Staff spoke inappropriately to client in care" is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met.

Deficiencies are being cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

Technical assistance was provided on staff training opportunities. 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: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240314165749
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: WATCH
FACILITY NUMBER: 557004883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2024
Section Cited
CCR
82072(a)(1)
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Personal Rights
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 was not met based on:
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The Licensee is required by the Regional Center to conduct training on personal rights, implicit bias and conduct a review of facility policies and procedures by 6/7/24. The Corrective Action Plan required by the Regional Center satisfies the Department's requirements and nothing further is requested.
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Interviews conducted with staff, clients and a service coordinator reveal that C1 was spoken to inappropriately and suspended or excluded from program. This poses a potential risk to the health, safety and personal rights of clients in care.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3