340313161-1-18-2023-23-CR-RROZ-CNEMKY-20230125084132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340313161
Report Date: 01/18/2023
Date Signed: 01/18/2023 12:27:43 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, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/26/2022 and conducted by Evaluator Yuvicela Diaz

PUBLIC

COMPLAINT CONTROL NUMBER: 23-CR-20221026122104

FACILITY NAME:	DEBORAH FILPULA FAMILY HOME		FACILITY NUMBER:	340313161
ADMINISTRATOR:	FILPULA, DEBORAH M.		FACILITY TYPE:	710
ADDRESS:	10496 DREXEL COURT		TELEPHONE:	(916) 366-3432
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	5	CENSUS: 6	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Matthew Filpula, DSPII		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Staff did not prevent inappropriate behaviors between minors

Minor sustained injuries while in care

INVESTIGATION FINDINGS:

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On January 18, 2022, at 12:10PM Licensing Program Analyst (LPA), Yuvi Diaz conducted a follow-up complaint investigation to the above facility and met with Matthew Filpula, DSPII The purpose of this inspection was to deliver findings for the above complaint allegations.

Prior to delivering complaint findings LPA Diaz reviewed the client’s file, conducted an inspection of the facility, and no deficiencies were cited at that time. LPA Diaz conducted 10 confidential interviews, obtained and reviewed the following documents: Incident Report, Individual Program Plan, Behavior Intervention Progress Report, Health Office Visits by Student, email pictures, and Face Sheet.

During the interview process LPA Diaz found that five out of the six clients are non-verbal, but LPA Diaz was able to observe their behaviors during their school hours. When interviewing C1, C1’s teacher stated

Report continues on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rosa Rodriguez
LICENSING EVALUATOR NAME: Yuvicela Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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 23-CR-20221026122104

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833

FACILITY NAME: DEBORAH FILPULA FAMILY HOME	FACILITY NUMBER: 340313161
	VISIT DATE: 01/18/2023

NARRATIVE

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that they were concern due to the amount of scratches and scabs C1 had. T1 stated that previously staff from the facility stated that C1 was tackled by C2. Additionally, LPA Diaz witness C2 slapping and hitting T3 on the face, and stomach during the interview. T3 stated that C2 is constantly hitting T3 or others. T3 also stated that C2 has self-behaviors and likes to pinch and scratch. Furthermore, LPA Diaz gathered documentation from the school C1 attends. School nurse documented that on 10/04/22 noted scratches on face and hands on C1. Nurse spoke to caretaker over the phone and stated C1 got in a scuffle with C2. On 10/13/22 nurse treated scratches and spoke to caretaker, and caretaker stated that C1 was tackled by C2. On 10/24/22 nurse treated C1 for new scratches on C1’s left hand and left arm. LPA Diaz observed pictures of the scratches and noted C1 to have a significant amount of scratches all over hands and arms. LPA Diaz only received one Incident Report on 10/23/22. Lastly, S3 witnessed C2 pinching C1 on 10/23/22 at approximately 9:30pm. Even though the Clients have been separated as of 10/28/22, C1 was injured by C2 on multiple occasions while in care.

Based on LPA’s observations, interviews which were conducted and record review(s), the preponderance of evidence has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Regulations, Division 6, Chapter 4 Article 6 are being cited on the attached LIC9099D.

An exit interview was conducted with Matthew Filpula, DSPII. A copy of this report and appeal rights was provided.

SUPERVISORS NAME: Rosa Rodriguez
LICENSING EVALUATOR NAME: Yuvicela Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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Control Number 23-CR-20221026122104

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 260
SACRAMENTO, CA 95833

FACILITY NAME: DEBORAH FILPULA FAMILY HOME	FACILITY NUMBER: 340313161
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/06/2023 Section Cited ILS 83072(d)(7)	1 2 3 4 5 6 7	83072(d)(7) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code section 16001.9, as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights: To be free of physical, sexual, emotional, or other abuse, and corporal punishment	1 2 3 4 5 6 7	A detailed written plan of correction will be submitted indicating how the facility will prevent this type of incident from occuring. Administrator to email LPA Diaz on or before 02/0223.
	8 9 10 11 12 13 14	This evidence was not met by:C1 was physically abused by C2 on multiple occasions while in care and staff did not prevent inappropraite behaviors between clients. School staff observed multiple scratches and bruises on C1 multiple times which poses a potential Health, Safety, or Personal Rights risks to client in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rosa Rodriguez
LICENSING EVALUATOR NAME: Yuvicela Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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