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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004679
Report Date: 05/26/2022
Date Signed: 05/26/2022 01:00:46 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, 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
11/15/2021 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20211115105132
FACILITY NAME:GLORIOUS HOMES #1FACILITY NUMBER:
347004679
ADMINISTRATOR:OFFIAH, MICHAEL & WINIFREDFACILITY TYPE:
740
ADDRESS:6901 FRANELA WAYTELEPHONE:
(916) 242-0735
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 5DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Michael Offiah, AdministratorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff refused home health to enter the facility

Staff is not following physician's orders
INVESTIGATION FINDINGS:
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On 5/26/2022, Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Michael Offiah, to conclude a complaint investigation into the allegations listed above. LPA wore an N-95 mask while on the premises.

During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Allegation: Staff refused home health to enter 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: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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 25-AS-20211115105132
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: GLORIOUS HOMES #1
FACILITY NUMBER: 347004679
VISIT DATE: 05/26/2022
NARRATIVE
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Interview with resident (R1) conducted on 11/24/2021 indicated that R1 was receiving visitors "if they wanted" and could see a nurse "if needed." Interview with Administrator indicated that a Home Health Nurse came to the facility to see R1 on a Saturday (believed date to be 11/20/2021) and met Home Health Nurse outside. Administrator told Home Health Nurse that R1 had already rejected services for Home Health, in which Home Health Nurse stated "OK" and left facility without entering. Administrator stated that Home Health Nurse could have come inside, but had left once told that R1 was rejecting Home Health.

Interview with relevant parties indicated that R1 rejected services for Home Health. R1 is not conserved and has a right to refuse health related services.

Allegation: Staff is not following physician's orders

Interview with R1 conducted on 11/24/2021 indicated that R1 was not experiencing pain and that R1 receives medications as needed. Interview with Administrator indicated that R1 receives medications as prescribed by primary care physician. During inspection conducted on 11/24/2021, LPA conducted a medication count for R1 comparing R1’s Centrally Stored Medication Form (CSM) with medications centrally stored for R1. LPA did not observe any errors when comparing medication count with R1's CSM.

Based on interviews conducted by the Department 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 Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2