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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700746
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:30:45 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.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/16/2023 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230816132021
FACILITY NAME:ASPIRE RESIDENTIAL CARE, LLCFACILITY NUMBER:
392700746
ADMINISTRATOR:FARKAS, KHANHFACILITY TYPE:
740
ADDRESS:121 MCKELVEY AVENUETELEPHONE:
(209) 834-7359
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:6CENSUS: 4DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maria MarcosTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff are not fingerprint cleared
INVESTIGATION FINDINGS:
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On 8-23-23 at 10:10am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with lead caregiver Maria Marcos and explained the purpose of the visit. Administrator Khanh Farkas was notified of LPAs visit and purpose and arrived at 3:00pm. During the investigation for this complaint, LPAs reviewed Department records including Guardian Employee Roster to determine fingerprint clearance eligibility. LPA also reviewed LIC 500 staffing roster, and staffing records for Staff1 (S1), S2, S3, S4, and S5.. Based on record reviews, it was determined that S2 was officially hired as staff on 10-16-22 and a fingerprint clearance date of 7-31-22 and associated with facility. Upon further record review it was determined that S5 is associated with other licensed facilities, but not associated with Aspire Residential Care, LLC at this time, and working in facility since 7-12-23. All other staff reviewed have verified fingerprint clearances.
As a result, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED. A citation is issued under Title 22, Division 6. A civil penalty in the amount of $500 is issued in addition to the citation. An exit interview was conducted with Khanh Farkas and a copy of this report was provided to Khanh. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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 27-AS-20230816132021
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.270
SACRAMENTO, CA 95833

FACILITY NAME: ASPIRE RESIDENTIAL CARE, LLC
FACILITY NUMBER: 392700746
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2023
Section Cited
CCR
87355(e)(2)
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Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by:
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Licensee to secure a transfer request and fingerprint clearance for S5 prior to S5 having further contact with residents in care. Proof of fingerprint clearance to by send to LPA by POC due date.

Licensee to read regulation 87355(e) and submit a signed declaration of understanding to LPA by POC due date.
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Based on record reviews, S5 is not currently associated with facility and demonstrates employment in facility since 7-12-23. This poses an immediate health and safety risk to residents 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: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3