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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201176
Report Date: 09/15/2023
Date Signed: 09/15/2023 04:10:35 PM

Substantiated


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
09/12/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20230912113556
FACILITY NAME:MARSTON CORPORATIONFACILITY NUMBER:
079201176
ADMINISTRATOR:UY, RONALDFACILITY TYPE:
740
ADDRESS:871 BRITTANY LANETELEPHONE:
(650) 255-9603
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 3DATE:
09/15/2023
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Kristabelle Alatas, Corperate board memberTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not ensure that facility medicine cabinet has a lock
INVESTIGATION FINDINGS:
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On 09/15/2023 at 1:05 PM, Licensing Program Analysts (LPA), J. Clancy-Czuleger and Alona Gomez arrived unannounced to deliver complaint findings for the above allegations. LPA met with Kristabelle Alatas, Corperate board member and explained the reason for the visit.

During the course of investigation, LPA obtained information, collected documents and interviewed _ staff. Based on LPA observation the facility is not locking the medication cabinet in a way that is inacsessable to the residents. There is a chain wraped around the knobs that falls off with the lightest touch.

On the allegation facility staff did not ensure that facility medicine cabinet has a lock the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited.

Exit interview conducted. A copy appeal rights, and this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
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 2
Control Number 15-AS-20230912113556
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: MARSTON CORPORATION
FACILITY NUMBER: 079201176
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2023
Section Cited
CCR
87465(h)(2)
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Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
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The facility agrees to relocate the medications to a locked location that is not accessible to persons in care. Proof of correction will be sent to CCLD by POC date.
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The facilities medication cabinet not locked properly and has a chain wraped around the knobs that falls off with the lightest touch
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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: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2