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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405802280
Report Date: 10/07/2024
Date Signed: 10/07/2024 08:08:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240118165403
FACILITY NAME:C.A.L.L. - VALDEZ HOUSEFACILITY NUMBER:
405802280
ADMINISTRATOR:KYLAN REYNOSOFACILITY TYPE:
740
ADDRESS:4305 VALDEZ AVETELEPHONE:
(805) 460-6663
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:4CENSUS: 2DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
07:33 PM
MET WITH:Alt. Administrator, Randyn Torres TIME COMPLETED:
09:34 PM
ALLEGATION(S):
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Facility staff speaks inappropriately to residents in care.
INVESTIGATION FINDINGS:
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 At 7:30am on 10/07/2024, Licensing Program Analyst (LPA) Jeffries conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Alternate Administrator, Randyn Torres and explained the purpose of the visit. During the investigation, LPA De Leon conducted an initial visit on 1/23/2024 from 10:00am to 2:08pm, where LPA interviewed staff and residents and requested documents.

As to the allegation of, "Facility staff speaks inappropriately to residents in care." It was alleged clients are being inappropriately spoken to and not being treated with dignity and respect by Staff 3 (S3). Multiple staff interviewed stated they raise their voice and lose their patience with clients. Multiple staff stated they have heard S3 raise their voice in R1’s room and in the kitchen. Staff interviewed stated they have seen S3 “mock” R1 and mimic R1. Staff stated S3 has been “verbally and mentally abusive” and shows aggression to the residents. Staff stated they have heard S3 speak unkindly to the residents but they stop it and tell S3 they cannot talk like that. One staff stated they had three other staff make reports about S3’s behavior to them. CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
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 29-AS-20240118165403
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: C.A.L.L. - VALDEZ HOUSE
FACILITY NUMBER: 405802280
VISIT DATE: 10/07/2024
NARRATIVE
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Some of these incidents included raising their voice in R1’s room, and being mean to R2 when asked if staff could hold their hand on a walk due to unsteadiness. Other staff confirmed they reported the issues through their chain of command. The staff reported these issues to the administrator. S3 also scolded R2 for taking keys, that R2 did not take. Staff noted R1 appeared to be “paranoid,” “skittish,” and “afraid” of S3, and wants to know where S3 is. Staff stated S3 also does not do things safely around client, such as turning the stove on and walking away from it.

LPA reviewed a write-up dated 1/8/2024 for S3 that discussed how to talk and redirect clients with a positive attitude; choose words that are encouraging instead of demeaning; work on tone and vocab in redirecting; give client time; encourage all clients in the home with positivity. S3 had another write up dated 6/25/2023 that stated proper chain of command must be followed; gossip is not tolerated and needs to be reported to on-call supervisor or HR; clients rights and mandatory reporting; proper redirection/de-escalation CPI techniques. S3 had additional counseling/disciplinary notice for 2/25/2021 due to a medication error; 7/14/2019 due to hitting a pothole with the facility van, causing damage; and 8/15/2018 due to being tardy on multiple shifts.

Exit interview, deficiencies cited on 9099-D, report given, appeal rights given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240118165403
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: C.A.L.L. - VALDEZ HOUSE
FACILITY NUMBER: 405802280
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(1) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews,
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POC: Administrator agrees to hold personal rights training with a Community Care Licensing certified vendor, with all staff by 10/21/2024.
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the licensee did not comply with the section cited above when residents were not treated with dignity, which posed a potential personal rights 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: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3