019200737-3-27-2023-15-AS-YFLS-CRRMNT-20230512094605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200737
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:54:33 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
11/08/2021 and conducted by Evaluator Lizette Francisco

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20211108123240

FACILITY NAME:	CALIFORNIA MENTOR-MARINEVIEW HOME		FACILITY NUMBER:	019200737
ADMINISTRATOR:	JOE FARRISH		FACILITY TYPE:	740
ADDRESS:	2420 MARINEVIEW DRIVE		TELEPHONE:	(916) 300-9510
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	4	CENSUS: 4	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Diane Truong, Quality Improvement		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Residents are not properly fed while in care
Residents grooming needs are not being met while in care
Staff do not have planned activities for the residents while in care
Staff mishandle residents medications while in care
Staff are not providing adequate care and supervision to the residents

INVESTIGATION FINDINGS:

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On 3/27/2023 starting at 11:40 AM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct complaint investigation for the above allegations. Upon arrival, LPA was greeted by Care Staff, Krinessa Santos and explained the purpose of the visit. Back-up Administrator was not available during visit.

During the course of the investigation, LPA obtained information, reviewed records, collected documents, interviewed staff and attempted to interview clients. It was alleged residents are not properly fed while in care. During record review of weight records for clients, LPA observed a decline in weight from January of 2021 to November of 2021 for C1 and C2. However, LPA observed a record of communication and recommendation between the facility and both clients' primary care physician and dietician. S1, S4 and S5 stated all clients receive a nutrition assessment quarterly and facility follows recommendations.

REPORT CONTINUES ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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-20211108123240

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: CALIFORNIA MENTOR-MARINEVIEW HOME	FACILITY NUMBER: 019200737
	VISIT DATE: 03/27/2023

NARRATIVE

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It was alleged residents grooming needs are not being met while in care. However, interview with 4 of 5 staff stated facility currently has a hair stylist that comes to the facility once a month to cut client's hair. In addition, routine grooming are provided by direct care staff.

It was alleged staff do not have planned activities for the residents while in care. Based on interview with staff, all clients are provided activities such as puzzles, blocks, toys, television, walking, art and crafts. 1 of 4 clients is provided activities by W1 from day program.

It was alleged staff mishandle residents medications while in care. LPA reviewed 4 clients Medication Administration Records and did not observed any issues. S1 and S5 stated facility does a two person check of medications to ensure there are no medications being mismanaged. LPA discovered during an interview with S1, S2, S3 and S4 that if there are any issues, then Administrator and Primary Care Physician are notified and staff will wait for instructions by the doctor. There is no forthcoming information from complainant.

It was alleged staff are not providing adequate care and supervision to the residents. Based on interview with S2 and S3, staff conducts a 30 minute quick round checks for all clients. 4 of 5 stated staff are checked every two hours. There is no forthcoming information from complainant.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided to Quality Improvement, Diane Truong.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Lizette Francisco
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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