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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801526
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:11:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2023 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20230519163246
FACILITY NAME:PCS-SARANACFACILITY NUMBER:
565801526
ADMINISTRATOR:ALEX RENTERIAFACILITY TYPE:
735
ADDRESS:10325 SARANACTELEPHONE:
(805) 659-2673
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:4CENSUS: 4DATE:
09/08/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Alex RenteriaTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility staff interfere in client's sleep schedule.
Facility staff do not accord client dignity in their personal relationships.
Facility staff sleep during their shift.
Facility staff did not provide client with appropriate meal service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. LPA M. Arroyo and Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnett conducted an initial complaint visit on 05/23/2023, and a subsequent complaint visit on 07/13/2023. On today’s visit, LPA Arroyo met with Administrator, Alex Renteria and the reason for the visit was explained. Entrance interview.

During the initial visit on 05/23/2023, LPA Arroyo and QAS Liz conducted a tour of the facility to ensure there were no health and safety concerns at 10:20 a.m., conducted interviews with the Regional Manager (RM) and Administrator between 10:35 a.m. and 12:27 p.m., and conducted a resident file review and requested copies of pertinent documents at 11:22 a.m. Additionally, LPA Arroyo and QAS Liz conducted an interview with Client #1 (C1) on 07/13/2023 at 10:36 a.m.

(Report Continued on LIC 9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
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 29-AS-20230519163246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PCS-SARANAC
FACILITY NUMBER: 565801526
VISIT DATE: 09/08/2023
NARRATIVE
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(Report Continued from LIC 9099...)

It was alleged that facility staff interfere in client’s sleep schedule. It was reported that staff persistently knock on C1’s bedroom door at night to talk and ask questions throughout the night interrupting their sleep. Interviews conducted with staff revealed that staff do wellness checks every two (2) hours throughout the night to check on the clients. Staff added that clients tend to leave their doors slightly open; therefore, allowing staff to not need to knock on client’s doors and disturb clients while sleeping. Interview conducted with C1 revealed C1 has not had staff go inside their room at night while they sleep. Furthermore, during the interview with C1, C1 stated they sleep well at night and had no concerns with the facility. Based on interviews conducted, the Department does not have sufficient evidence to support the allegation of “facility staff interfere in client’s sleep schedule”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that facility staff do not accord client dignity in their personal relationships. It was reported that C1 did not feel comfortable talking to staff or reporting anything because they felt they would get into trouble. Record review of C1’s Physicians Report revealed C1 is able to follow instructions, able to communicate, and does not get easily confused. Interview with the Administrator revealed clients and staff have created relationships between each other and communicate well. Interview conducted with C1 revealed they get along with facility staff and are able to approach staff at any time. Additionally, C1 stated feeling comfortable around staff and reported having conversations with them as well. Based on record review and interviews conducted, the Department does not have sufficient evidence to support the allegation of “facility staff do not accord client dignity in their personal relationships”. Therefore, this allegation is deemed Unsubstantiated at this time.

(Report Continued on LIC 9099C...)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230519163246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PCS-SARANAC
FACILITY NUMBER: 565801526
VISIT DATE: 09/08/2023
NARRATIVE
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(Report Continued from LIC 9099C...)

It was also alleged that facility staff sleep during their shift. It was reported that the night shift staff were observed coming into work at night and falling asleep. Record review of facility’s staff schedule revealed the facility maintains at least two (2) staff on weekends and three (3) staff on weekdays during the night shift. Interviews with management revealed staff have previously communicated about taking naps during their breaks and/or lunch provided. The staff will take turns and take separate breaks and/or lunch to cover each other. Additionally, while conducting an interview with C1, C1 denied observing night shift staff sleeping and stated the night shift staff is always awake when they wake up. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility staff sleep during their shift”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was further alleged that facility did not provide client with appropriate meal service. It was reported that clients are not provided breakfast. Review of documents revealed the facility maintains a sufficient supply of food at the facility by doing online orders from the grocery store and having it delivered to the facility weekly. Additionally, during the facility tour, the LPA observed an adequate amount of perishable and non-perishable food. Interview with the Administrator revealed doctor’s appointments and day program schedules have an impact on each client’s breakfast schedule. However, facility staff ensure breakfast is ready for all clients every morning. Interview conducted with C1 revealed meals are provided every day and snacks are available in between meals and after dinner upon request. Furthermore, C1 stated the facility always has food and reported having no concerns with the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility did not provide client with appropriate meal service”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3