019200693-1-17-2024-15-AS-KHOS-D2DNDX-20240212092303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200693
Report Date: 01/17/2024
Date Signed: 01/17/2024 05:35:41 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2024 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20240109101458

FACILITY NAME:	A-N-D CARE HOMES		FACILITY NUMBER:	019200693
ADMINISTRATOR:	HAMZA, MORENIKE		FACILITY TYPE:	740
ADDRESS:	3284 COURTHOUSE PLACE		TELEPHONE:	(510) 574-9305
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	3	CENSUS: 2	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Morenike 'Nikky' Hamza/Administrator-Licensee		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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-Licensee did not ensure that resident's room was free from clutter resulting in injury to resident while in care.

-Staff did not respond to resident's requests for assistance in a timely manner.

-Licensee did not honor resident's notice to terminate.

INVESTIGATION FINDINGS:

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At 1:10 p.m., Licensing Program Analyst (LPA) Delmundo, arrived unannounced to investigate the above allegations. LPA met with Morenike 'Nikky' Hamza, administrator, and informed the reason for visit.

During the course of investigation, LPA interviewed R1's nurse (N1), 2 residents, and 2 staff members, administrator/licensee, and inspected R1's room. LPA reviewed and obtained copies of resident (R1) records.

Allegation: Licensee did not ensure that resident's room was free from clutter resulting in injury to resident while in care.
It was alleged that R1 would put mounds and mounds of boxes in R1's bedroom and bed. The administrator was asked to do something but didn't do anything. It was further alleged that it got to a point where there's not enough room for R1 to move his legs resulting to R1 developing contractures.
.....continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 15-AS-20240109101458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: A-N-D CARE HOMES	FACILITY NUMBER: 019200693
	VISIT DATE: 01/17/2024

NARRATIVE

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R1 stated he has stuff in his room and bed but has room to move his legs and can move from his back to side when in bed. Administrator stated she has cleaned and cleared R1's room and placed R1's stuff underneath the bed and in the side yard; however, R1 kept on putting them back to his bed. This was brought up to R1's case manager and N1. N1 stated she does not believe the clutters resulted to R1's contractures. N1 further stated that the administrator cleans R1's room but when R1 comes back, R1 put the stuff back to his bed. N1 stated that even R1 does not have clutter in his bed, R1 is still at risk of contractures due to R1's medical condition and R1 not following what the therapist instructed R1 to do.

Allegation: Staff did not respond to resident's requests for assistance in a timely manner.
R1 stated staff attended to him within 5 to 10 minutes when he pressed his buzzer but there are times it takes 30 minutes and staff (S2) said she didn't hear. S2 stated whenever the residents pressed their buzzes, signal is transmitted to the 2nd floor and dining area on the first floor. S2 stated she always attend to the residents when they pressed their buzzers. Administrator stated she always attend to the residents and check them every 30 minutes during the day and every 3 hours at night. S1 stated the staff attend to the residents timely. R2 indicated he seldom press his buzzer. When he needs help, he just call the staff and the staff responds right away,

Allegation: Licensee did not honor resident's notice to terminate.
It was alleged that the licensee refused to accept R1's termination notice, and kept charging R1 past R1's termination notice.

The administrator denied the allegation and provided copy of R1's 30-day notice dated December 13, 2023. The administrator stated that she told R1 that she is not going to kick R1 out until R1 found a Skilled Nursing Facility (SNF) to move into. R1 stated he handed the notice December 2023, the social worker arranged to have him moved to SNF and the event unfolded the way it is.

Based on all information obtained, the allegations were closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there's not a preponderance of evidence to prove that the alleged violation occurred.

No deficiency cited. Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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