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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701163
Report Date: 08/18/2023
Date Signed: 08/18/2023 11:56:40 AM

Unsubstantiated


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
06/26/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20230626114456
FACILITY NAME:RCFE CARE & RESPITE HOUSEFACILITY NUMBER:
392701163
ADMINISTRATOR:SANTIAGO, ROLANDOFACILITY TYPE:
740
ADDRESS:663 CHICAGO AVENUETELEPHONE:
(209) 207-4964
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:6CENSUS: 4DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rolando SantiagoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not prevent resident from sexually abusing another resident in care
Licensee does not ensure there is Internet access available to residents

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/18/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation and deliver findings in relation to the above listed allegations. LPA Jensen met with Rolando Santiago and explained the purpose of today's visit.

Allegation 1: Facility staff did not prevent resident from sexually abusing another resident in care
LPA Jensen conducted record reviews including 3 of 3 resident files. LPA Jensen also conducted interviews with 3 of 3 residents and 4 of 5 staff members. Based on a review of the client file, Resident 1 (R1) has a documented history of making false allegations of sexual abuse. During interviews conducted on 7/28/23, the alleged victim denied any sexual abuse since moving in to the facility. The alleged perpetrator or Resident 2 (R2) denied the allegations. The remaining resident denied ever having witnessed any sexual abuse. All staff members interviewed, including NOC shift staff deny ever having knowledge of or witnessing sexual abuse within the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
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 4
Control Number 27-AS-20230626114456
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: RCFE CARE & RESPITE HOUSE
FACILITY NUMBER: 392701163
VISIT DATE: 08/18/2023
NARRATIVE
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Continued from LIC 9099...
The allegation of facility staff did not prevent resident from sexually abusing another resident in care is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.

Allegation 2: Licensee does not ensure there is Internet access available to residents
LPA Jensen interviewed the Administrator who advised that there was an internet outage for a couple of days through the provider AT&T. The Administrator showed LPA Jensen a transcript of an online chat with the internet provider stating they will receive bill credit as a result of the outage. The Administrator showed LPA Jensen the facility's online internet account and LPA Jensen verified the facility has this recurring expense set up with autopay thereby making it unlikely that there were any delinquent payments. LPA Jensen interviewed R3 who confirmed the facility has internet access but "sometimes they watch a movie and the internet gets tired and shuts off." R3 was unable to state how often or when that has happened. Based on the records reviewed and interviews conducted the allegation of Licensee does not ensure there is Internet access available to residents is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened, the preponderance of evidence does not prove it.

No deficiencies were observed during the course of this investigation. An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
06/26/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20230626114456

FACILITY NAME:RCFE CARE & RESPITE HOUSEFACILITY NUMBER:
392701163
ADMINISTRATOR:SANTIAGO, ROLANDOFACILITY TYPE:
740
ADDRESS:663 CHICAGO AVENUETELEPHONE:
(209) 207-4964
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:6CENSUS: 4DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rolando SantiagoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that all burners on the stove are in working order
Facility staff mismanaged clients medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/18/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation and deliver findings in relation to the above listed allegations. LPA Jensen met with Rolando Santiago and explained the purpose of today's visit.

Allegation 1: Licensee does not ensure that all burners on the stove are in working order
LPA Jensen interviewed Administrator who advised that the facility has a 4 burner stove and the 2 rear burners were not working. The parts need for repair were ordered but were on back order. The facility also maintains a portable electric 2 burner unit that is used primarily for client cooking activities. The Administrator advised that due to the parts taking longer than anticpated the range with the faulty burners was replaced and the facility always had the ability to cook meals on the stove top at all times. LPA Jensen interviewed R3 who confirmed she has been able to do her cooking and most recently made tacos on portable range. The allegation of Licensee does not ensure that all burners on the stove are in working order is UNFOUNDED.
Continued on LIC 9099C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20230626114456
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: RCFE CARE & RESPITE HOUSE
FACILITY NUMBER: 392701163
VISIT DATE: 08/18/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC 9099A...
A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis.

Allegation 2: Facility staff mismanaged clients medication
LPA Jensen interviewed the Administrator who advised that on the date in question, 5/5/23, R1 and Resident 3 (R3) were having a heated verbal disagreement over art supplies in the morning. When it was time for the medication pass R1 took her medication and R3 refused her medication because she was angry and wanted personal space. After a few hours she agreed to take her medication. The facility faxed the physician who promptly responded there were no concerns as it was only a few hours late. LPA Jensen reviewed R3's MAR and verified that medication has been administered as prescribed on all occasions other than 5/5/23. LPA Jensen reviewed the fax sent to the physician regarding this matter and the records support the Administrator's explanation. LPA Jensen interviewed R3 who denied ever having an issue receiving medication as prescribed.

No deficiencies were observed as a result of this complaint investigation. An exit interview was conducted and a copy of this report was given.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4