425850230-2-7-2024-29-AS-KBUY-D2VRGZ-20240228120135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850230
Report Date: 02/07/2024
Date Signed: 02/07/2024 01:45:55 PM

Unsubstantiated

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
01/22/2024 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20240122160108

FACILITY NAME:	A CASA RANCH		FACILITY NUMBER:	425850230
ADMINISTRATOR:	SORIANO, APRILYN A		FACILITY TYPE:	740
ADDRESS:	502 N. RANCH STREET		TELEPHONE:	(650) 544-1485
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	6	CENSUS: 4	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	01:22 PM
MET WITH:	Debby Acquistapace, Caregiver and Aprilyn Soriano, Administrator (over the phone)		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff left resident unattended at facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for the above allegation. LPA Olson interviewed Staff on 1/29/24 and 2/7/24, Residents and Administrator on1/29/24 and requested relevant documents. During today’s visit, LPA met with Caregiver and Administrator (over the phone) and explained the reason for the visit.

On the allegation: Staff left resident unattended at facility. It was alleged that during the facility's Christmas party, a resident was left alone at the facility because all the staff left to go to the party. LPA interviewed all 4 residents on 1/29/24 who stated they have never been left alone at the facility. One resident interviewed stated they heard someone was left alone at the facility, they don’t remember who told them but they asked and staff said no one was left alone. Another resident stated Resident 1 (R1) was unable to go to the party and had to stay because they were too sick but Staff 1 (S1) was here and stayed with R1 the whole time.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240122160108

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: A CASA RANCH	FACILITY NUMBER: 425850230
	VISIT DATE: 02/07/2024

NARRATIVE

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LPA interviewed Administrator who stated the facility had a Christmas Party on 12/25/23 which started at 1pm. R1 was on Hospice and bedridden so they couldn’t go. Administrator stated R1 remained at the facility with S1 and S1 stayed with R1 the whole time. The administrator stated Staff 2 (S2) came from the other facility to help take residents to the party. Staff 3 (S3) stayed with the residents at the other facility, and Administrator and S2 took residents over one by one. Administrator also stated S2 brought food over for S1 and R1 and there were many witnesses that can prove S1 was not at the party, so never left. LPA interviewed S1 who stated they worked on 12/25/23 from 7am-5pm and could not go to the Christmas party because R1 was too sick. S1 stated they know the rules and stayed with R1 the whole time. LPA interviewed S2 who stated they came over to the facility to help take the residents one by one. S2 stated S1 stayed the whole time and never left R1. Based on the information obtained there is not enough evidence to substantiate, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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