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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001715
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:07:03 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Mohamed Filouane
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20211028152847
FACILITY NAME:CARING FAMILIES-BV2FACILITY NUMBER:
347001715
ADMINISTRATOR:MICHELLE MACIASFACILITY TYPE:
740
ADDRESS:8716 BRAY VISTA WAYTELEPHONE:
(916) 686-0420
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Angela Bershell & Michelle MaciasTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
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9
Residents medications are mishandled while in care.
INVESTIGATION FINDINGS:
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2
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5
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On 11/03/21, Licensing Program Analyst (LPA) Mohamed Filouane, conducted a 10-day complaint on-site inspection. LPA entered the facility and had his temperature taken and answered a COVID-19 questionnaire by a staff member, following the facility's health and safety procedures. LPA Filouane then met with staff member Angela Bershell, explained the purpose of the visit, reviewed medication logs, interviewed residents and staff, then delivered the findings of the investigation.

During the investigation, LPA Filouane reviewed medication logs, interviewed the Administrator, and interviewed residents and staff regarding the allegation of medications being mishandled while in care. The Administrator denied this allegation. The Administrator stated residents take their medication in the presence of a staff member. The staff member denied this allegation during the interview with LPA. The staff member stated each resident is observed to confirm their medication has been taken. Medication log review revealed no missed days or times of medication distribution. In interviews with the LPA, residents denied the allegation, as well. After review, this allegation is unfounded.

At approximately 1:45 PM, Administrator Michelle Macias arrived at the facility.

The Department has investigated the complaint. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis.

Exit interview conducted with the Administrator. The Administrator was given a signed copy of this report.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Mohamed Filouane
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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