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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802410
Report Date: 06/29/2022
Date Signed: 06/29/2022 03:15:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2020 and conducted by Evaluator Kelly Dulek
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20200603170953
FACILITY NAME:PEOPLE'S CARE GOODENOUGHFACILITY NUMBER:
565802410
ADMINISTRATOR:JOSHUA CRATIONFACILITY TYPE:
735
ADDRESS:2591 GOODENOUGH RDTELEPHONE:
(805) 524-5617
CITY:FILLMORESTATE: ZIP CODE:
93015
CAPACITY:6CENSUS: 5DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Tanya KramerTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Insufficient staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint inspection with the purpose of delivering findings for the allegation listed above. LPA met with Administrator Tanya Kramer at 2:45 PM. Entrance interview conducted.

During today’s visit, LPA and Administrator toured the facility at 2:48PM. No health and safety hazards were identified during facility tour. Previously, on 06/08/2020, LPA Dulek conducted an initial complaint inspection virtually with the facility Administrator Joshua Cration. During which, LPA conducted a telephone interview with the Administrator at 4:32PM. The LPA requested copies of the current staff schedule and the past two weeks’ schedules as well as a staff roster including current contact information for all staff to be emailed to the LPA. On various dates throughout the month of June 2020, LPA and Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett conducted telephone interviews with seven (7)

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME:
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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-20200603170953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: PEOPLE'S CARE GOODENOUGH
FACILITY NUMBER: 565802410
VISIT DATE: 06/29/2022
NARRATIVE
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staff members, as well as one (1) client and one (1) witness. LPA also reviewed pertinent documents. The following was then determined:

Staff interviews revealed that the facility has been understaffed. 7 of 7 staff interviewed indicated various times the facility had only one staff on the permanent side. On Friday 06/12/2020, only 1 staff was present on the permanent side. Staff reported this is a consistent problem during the NOC shift and on the weekends. One staff indicated they were consistently 2 staff short during the 2:00 – 10:00PM shift January 2020-March 2020. Staff interview indicated there are staff scheduled to work on the schedule provided to LPA that are out on leave or otherwise unavailable to work. The staff schedule provided to the LPA was compared to a photograph of the schedule posted at the facility and LPA confirmed differences in the schedules. Client interview revealed that Client #1 (C1) frequently does not have a 1:1 staff, particularly at NOC shift. Witness interview revealed that the facility should have 3 staff on the permanent side and one staff on the crisis side during the day and evening shift. NOC shift is required to be 2 staff on the permanent side and one additional on the crisis side. Of the 5 total clients in care, 3 are on a 1:1 and the remaining 2 are a 1:2 staffing ratio. Review of staff schedule for the weeks of 05/31/2020 – 06/06/2020 and 06/07/2020 – 06/13/2020 revealed the LVN scheduled as the fourth staff on Monday, Tuesday, and Friday day shifts. However, QA indicated the nurse is not allowed to be counted in ratio, as they are not a trained caregiver. Schedule review also revealed from 8:00PM – 10:00PM on the following dates, there were only 3 total staff scheduled: 06/03/2020, 06/04/2020, 06/10/2020, and 06/11/2020. Messages reviewed indicated on 03/16/2020 staff were alone for the third weekend in a row, on 03/25/2020 there were two staff working for the five total clients. Email dated 05/07/2020 sent between QA and facility Administration referenced an earlier telephone conversation and indicated “program support hours not being covered” at the facility. Therefore, based on interview and record review, the allegation “insufficient staffing” is deemed SUBSTANTIATED at this time.

The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via email.

SUPERVISORS NAME:
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20200603170953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PEOPLE'S CARE GOODENOUGH
FACILITY NUMBER: 565802410
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2022
Section Cited
CCR
80078(a)
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80078 Responsibility for providing care and supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
Based on staff schedule review, and interviews there were 3 total staff
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Administrator agreed to have a plan in place for backup staffing, as needed. Currently, the facility has sufficient staffing, as confirmed by LPA during the 06/30/2022 visit, POC cleared.
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scheduled from 8:00PM – 10:00PM on 4 dates in June with 5 clients, during a time when there are 3 clients that require 1:1 staffing, and 2 additional clients requiring 1 staff for both clients, leaving the facility understaffed, which poses an immediate health and safety risk to 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:
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
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