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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005713
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:59:55 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, 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
08/17/2022 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20220817154450
FACILITY NAME:DANIEL RESIDENTIAL CARE HOME LLCFACILITY NUMBER:
347005713
ADMINISTRATOR:DIALA, JOYCEFACILITY TYPE:
740
ADDRESS:4295 AMAPOLA WAYTELEPHONE:
(916) 717-3263
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 4DATE:
12/13/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:care staff Helen AgbirioguTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Untrained staff

Staff did not administer resident's medication as prescribed

Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met by care staff Helen Agbiriogu who called administrator Emmanuel Diala. LPA Lund spoke administrator Emmanuel Diala and explained the reason for the visit. Administrator Emmanuel Diala could not make the visit today and gave permission for care staff Helen Agbiriogu to sign required paperwork.

Untrained staff- Based on records reviewed and interviews conducted with staff, and residents. It was reported that medications were not give timely. LPA Lund reviewed resident (R1) facility records R1 was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. R1 complained to staff and Administrators Emmanuel & Joyce Diala that R1 wanted to take unprescribed medications.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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 3
Control Number 27-AS-20220817154450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713
VISIT DATE: 12/13/2022
NARRATIVE
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LPA Lund reviewed facility training records for staff. On 1/26/2021 and 6/7/2022. On 1/26/2021 staff were trained on how to assist residents with medications intake, how to store and destroy medications, report/document medication errors and etc. On 6/7/2022 staff were trained on the process of handling medications, administration of medication logging, in destruction of medication, process of reading labels, recording, reporting, storage and other information of medication.

LPA Lund interviewed staff and residents in care. Staff stated, “That they only give medications according to the MAR and give medications in a timely manner”. Residents stated, “That they get medications when ask for and when staff give it to them when it is time to be given.”

Based on facility records, interviews with staff and residents on the information provided, it was unclear if the facility has untrained staff therefore the allegation was deemed UNSUBSTANTIATED.

Staff did not administer resident's medication as prescribed- It was reported that staff didn’t read the proper Medication Administration Record (MAR) for Resident (R1). Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that R1 was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1.

LPA Lund reviewed Medication Administration Record (MAR) from the facility Medication Administration Record (MAR) dated August 3, 2022 through August 31, 2022. R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022 R1 was admitted to the hospital. R1 came back to the facility from the hospital August 19, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return to the facility. LPA Lund observed that MAR for R1 for August 2022 and it was properly filled out..

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20220817154450
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: DANIEL RESIDENTIAL CARE HOME LLC
FACILITY NUMBER: 347005713
VISIT DATE: 12/13/2022
NARRATIVE
1
2
3
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5
6
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32
LPA Lund reviewed facility training records for staff. On 1/26/2021 and 6/7/2022. On 1/26/2021 staff were trained on how to assist residents with medications intake, how to store and destroy medications, report/document medication errors and etc. On 6/7/2022 staff were trained on the process of handling medications, administration of medication logging, in destruction of medication, process of reading labels, recording, reporting, storage and other information of medication.
Based on facility records, interviews with staff and residents on the information provided, it was unclear if the staff did not administer resident's medication as prescribed therefore the allegation was deemed UNSUBSTANTIATED.

Staff mismanaged resident's medication- It was reported that staff didn’t give out the proper medications to R1. Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that resident (R1) was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1.

LPA Lund reviewed Medication Administration Record (MAR) from the facility Medication Administration Record (MAR) dated August 3, 2022 through August 31, 2022. R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022 R1 was admitted to the hospital. R1 came back to the facility from the hospital on August 20, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return to the facility. LPA Lund observed that MAR for R1 for August 2022 and it was properly filled out..



Based on facility records, interviews with staff and residents on the information provided, it was unclear if the staff mismanaged resident's medication therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.


An exit interview was conducted with care staff Helen Agbiriogu
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3