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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001629
Report Date: 05/07/2021
Date Signed: 05/07/2021 05:40:51 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2020 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 27-AS-20200818154102
FACILITY NAME:MARIA'S HOME CAREFACILITY NUMBER:
347001629
ADMINISTRATOR:ANDREI COSTEAFACILITY TYPE:
740
ADDRESS:5914 CANARY DRIVETELEPHONE:
(916) 344-5487
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 4DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Andrei Costea, AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Administrator interfering with resident receiving medical care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Michael Hood met with Licensee, Andrei Costea, to conduct an inspection regarding a complaint investigation of violation of Administrator interfering with resident receiving medical care.

Relevant party indicated that Administrator interfered with resident R1 receiving a COVID-19 test on 8/11/2020. Written request for COVID-19 test indicated that transportation for R1 would arrive at facility at 11:30 AM and that appointment was scheduled for 12:30 PM. Sign out form indicated that R1 left facility for appointment at 12:09 PM. All interviews conducted by LPA indicated that R1 left for appointment on 8/11/2020. LPA also received a receipt indicating that R1 received a COVID-19 test prior to appointment on 8/6/2020 and received a negative test result.

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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 4
Control Number 27-AS-20200818154102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MARIA'S HOME CARE
FACILITY NUMBER: 347001629
VISIT DATE: 05/07/2021
NARRATIVE
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CCLD does not require residents to receive COVID-19 tests. CCLD recommends COVID-19 testing for resident if they are returning from hospitalization or SNF.

Based on interviews conducted by LPA and records reviewed, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Licensee and a copy of this report was provided to the facility. The signature of Licensee on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2020 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 27-AS-20200818154102

FACILITY NAME:MARIA'S HOME CAREFACILITY NUMBER:
347001629
ADMINISTRATOR:ANDREI COSTEAFACILITY TYPE:
740
ADDRESS:5914 CANARY DRIVETELEPHONE:
(916) 344-5487
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 4DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Andrei Costea, AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
1
2
3
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9
Staff not assisting resident with meals

Staff not assisting resident with hygiene

Caregiver is impaired during work hours
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Michael Hood met with Licensee, Andrei Costea, to conduct an inspection regarding a complaint investigation of violation for the above allegations.

During the investigation, LPA toured the facility, interviewed facility staff and residents, and obtained documentation pertinent to the investigation.

Allegation: Staff not assisting resident with meals

Interviews conducted by LPA with staff members S1, S2, S3, residents R2, and R3 indicated that all residents receive three meals a day with snacks between meals. During inspection of facility, LPA observed a 2-day perishable and 7-day nonperishable food supply at the facility.

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20200818154102
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: MARIA'S HOME CARE
FACILITY NUMBER: 347001629
VISIT DATE: 05/07/2021
NARRATIVE
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LPA reviewed R1’s LIC 602 for 12/19/2019 and 7/10/2020. LIC 602 for 12/19/2019 indicated R1’s weight as 83 kilograms (183 lbs) and height 5’8”. LIC 602 for 7/10/2020 indicated R1’s weight as 160 lbs and height 5’7”.

Allegation: Staff not assisting resident with hygiene

Interviews conducted by LPA with S1, S2, and S3 indicated that R1 received 3 showers a week, daily continence care, daily cleaning as needed, and a sufficient supply of clothing. Interview with S3 indicated that R1 had a skin condition that required daily cleaning from staff at the facility. Interviews with R2 and R3 indicated that hygiene needs are being met.

Allegation: Caregiver is impaired during work hours

All interviews conducted by LPA indicated that no one had witnessed a caregiver impaired while working at the facility. During facility inspection, LPA did not observe alcohol at the facility nor impaired staff.

Based on interviews conducted by LPA, observations during inspection, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Licensee and a copy of this report was provided to the facility. The signature of Licensee on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4