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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700901
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:38:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
07/28/2023 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20230728115741
FACILITY NAME:A LOVING AND JOYFUL HOME RCFEFACILITY NUMBER:
312700901
ADMINISTRATOR:HEYDON, ANITAFACILITY TYPE:
740
ADDRESS:609 HERNANDEZ LANETELEPHONE:
(916) 200-8447
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
08/15/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CaregiverTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are not background cleared to care and supervise residents in care.
INVESTIGATION FINDINGS:
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 On 8/15/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Caregiver to deliver complaint findings for the above allegation. Administrator, Anita Heydon, arrived for the report review.
LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.
Records review found that S1, S3, S4, S5 and S6 are not associated to the facility. Administrator stated that they are experiencing difficulties accessing the Guardian system. S1 is considered by the Administrator to be a volunteer who does not do resident care. However, statements provided found that S1 does assist with care at times and is unsupervised with residents at times. Regardless, Volunteers are required to obtain a criminal record clearance before presence in the facility. S1 was associated to this home on 8/8/23. S3 has no record of fingerprint clearance. S3 worked at this home for approximately seven months. S4 had no known prior clearance before 8/5/23 and is “in process”. S5 criminal record clearance found their last clearance was in 1997.
Report continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
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 59-AS-20230728115741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: A LOVING AND JOYFUL HOME RCFE
FACILITY NUMBER: 312700901
VISIT DATE: 08/15/2023
NARRATIVE
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LPA discussed with Administrator that as they are aware of the need for criminal records clearance before staff are present at the facility, they could have discussed their challenges with Guardian and use of paper transfer request forms.
In addition to citations issued, civil penalties are to be applied.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with Anita Heydon. Copy of this report, civil penalties and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20230728115741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: A LOVING AND JOYFUL HOME RCFE
FACILITY NUMBER: 312700901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2023
Section Cited
CCR
87355(b)(1)(D)
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Criminal Record Clearance (b) In addition to the applicant, the provisions of this section shall apply to criminal convictions of the following persons: (1) (D) Any staff person, volunteer, or employee who has contact with the clients. this requirement was not met based on interviews and records reviews that found 5 of 6 staff
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Staff either no longer work at the home or have been criminal record cleared since this investigation was conducted.

Licensee will attend and submit proof of attendence of staff Administrator retraining for Criminla record clearance.
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were not criminal record cleared and or associated to this home.
This posed an immediate risk to residents.
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By the POC date of 8/16/23 licensee will submit proof of a scheduled training within 7 days.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3