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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700746
Report Date: 09/26/2023
Date Signed: 09/26/2023 03:52:44 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
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:
09/26/2023
UNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Maria HinautanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not meeting residents needs
INVESTIGATION FINDINGS:
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On 9-26-23 at 1:26pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the complaint allegations noted above. LPA met with lead caregiver Maria Hinautan and explained the purpose of the visit. Administrator Khanh Farkas was made aware by telephone of purpose and these findings. During this investigation, LPAs Bilger and Villanueva conducted interviews with four residents in care, four staff members, and two additional witnesses. Additionally, LPAs reviewed facility file documentation including needs and service plans, appraisals, medication logs, and physician’s reports for residents in care. LPAs also conducted facility observations on 8-23-23 and 9-21-23.

Allegation: Staff are not meeting resident needs. LPAs conducted interviews with staff, residents, and witnesses as noted above. LPAs also conducted facility observations on the dates indicated above. Additionally, LPAs reviewed facility file documentation including physician’s reports, needs and service plans, and appraisals for residents in care.
{Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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 5
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
VISIT DATE: 09/26/2023
NARRATIVE
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Based on records reviewed, it was revealed that 2 of 4 residents, resident1 (R1), and R3 were identified as requiring one on one (1:1) monitoring all or most of the time. It was further revealed that R2 requires 2-person assist with bathing and special observation at night due to confusion and forgetfulness. LPAs review of staffing schedule and interviews conducted revealed one staff member is on duty per shift consistently. LPAs observed 1 caregiver on duty during observations during both morning and afternoon shifts. Additionally, based on interviews, it was revealed that toileting and incontinence care for R2 is delayed due to one caregiver on duty per shift.

As a result, there is a preponderance of evidence to conclude that staff are not effectively meeting resident needs as identified through record reviews, interviews, and observations, therefore, this allegation is SUBSTANTIATED. Citations are issued under Title 22, division 6 as a result of this investigation and indicated on LIC 9099D. An exit interview was conducted with Maria Hinautan and a copy of this report was provided to Maria including LIC 811. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/27/2023
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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Licensee will submit an appropriate staffing plan suitable to meeting the needs of residents in care. Plan to be submitted to LPA by POC due date.
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Based on record review, interviews, and observations, Licensee did not ensure appropriate numbers of staff available to meet the identified needs of residents in care. This poses an immediate health, safety, and resident rights risk to residents in care.
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Licensee will read regulation 87411(a) and submit a signed declaration of understanding to LPA by POC due date.
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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: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
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:
09/26/2023
UNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Cecilia CatbaganTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not qualified
Staff not qualified to give medications.
INVESTIGATION FINDINGS:
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On 9-26-23 at 1:26pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the complaint allegations noted above. LPA met with lead caregiver Maria Hinautan and explained the purpose of the visit. During this investigation, LPAs Bilger and Villanueva conducted interviews with four residents in care, four staff members, and two additional witnesses. Additionally, LPAs reviewed facility file documentation including staff training records, needs and service plans, appraisals, medication logs, and physician’s reports for residents in care. LPAs also conducted facility observations on 8-23-23 and 9-21-23.
Allegation: Staff are not qualified. LPAs conducted interviews with staff, residents, and witnesses as noted above. LPAs also reviewed training records for staff members as noted above. Based on record reviews, it was indicated that 5 of 5 staff members have received initial and on-going caregiver annual training per regulatory requirements. Based on interviews and observations it was further revealed that staff demonstrated appropriate knowledge towards general job requirements. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
VISIT DATE: 09/26/2023
NARRATIVE
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 Additionally, based on interviews, there were no substantial corroborated statements to reveal unqualified staff on duty. As a result of this investigation, there is not a preponderance of evidence to conclude unqualified staff are providing care for residents, therefore, this allegation is UNSUBSTANTIATED.

Allegation: Staff not qualified to give medications. LPAs conducted interviews with staff, residents, and witnesses as noted above. LPAs also reviewed training records for staff members noted above and conducted facility observations on the dates indicated above. Based on record reviews, it was indicated that 5 of 5 staff members have received medication training per regulatory requirements. Based on interviews and observations it was further revealed that staff demonstrated appropriate knowledge towards general job requirements regarding medication handling. Additional interviews further revealed no substantial corroborated statements of staff unqualified to give medication. As a result of this investigation, there is not a preponderance of evidence to conclude staff are unqualified to give medications, therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Maria Hinautan and a copy of this report was provided to Maria including LIC 811. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5