011400627-2-6-2023-15-AS-KHOS-CP4MNC-20230216084519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 011400627
Report Date: 02/06/2023
Date Signed: 02/06/2023 10:33:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
11/21/2022 and conducted by Evaluator Catherine Lin

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20221121172630

FACILITY NAME:	ST. PAUL'S TOWERS		FACILITY NUMBER:	011400627
ADMINISTRATOR:	YUEN, CONNIE		FACILITY TYPE:	741
ADDRESS:	100 BAY PLACE		TELEPHONE:	(510) 835-4700
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY:	320	CENSUS: 232	DATE:	02/06/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cherry Marcelo, Health Care Administrator		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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9

Resident was left in depends for a long period of time.

INVESTIGATION FINDINGS:

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On 2/6/23 at 9:00am, Licensing Program Analyst (LPA) C. Lin conducted an unannounced subsequent complaint investigation regarding the above allegations and deliver investigation findings. LPA met with Health Care Administrator and explained the purpose of the visit.

The Department has investigated this allegation and per records review, observation, and interviews, found that facility staff denied to left resident for a long period of time. Staff stated that they changed resident regularly on duty. Staff S1 and S2 stated that resident was difficult to be changed that required 2 staff assistance most of the time. Staff S4 observed that NOC shift staff was able to change resident without asking other staff for help but took a longer time. S3 stated that NOC shift staff did call S3 for help to change resident as needed. Staff stated that resident refused to be changed sometimes, staff had made efforts to meet resident's needs. Resident was observed in good hygiene condition in both investigation visits.

Continue 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

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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Control Number 15-AS-20221121172630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ST. PAUL'S TOWERS	FACILITY NUMBER: 011400627
	VISIT DATE: 02/06/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on the information obtained, the allegation is unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiency cited. Exit interview conducted with Health Care Administrator and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Catherine Lin	TELEPHONE: 510-622-2053
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC9099 (FAS) - (06/04)

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