<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011441112
Report Date: 10/14/2022
Date Signed: 10/14/2022 04:08:18 PM

Substantiated


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
05/02/2022 and conducted by Evaluator Catherine Lin
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20220502111732
FACILITY NAME:ABILITY NOW BAY AREA, INC.FACILITY NUMBER:
011441112
ADMINISTRATOR:DECOSTE, MAUREENFACILITY TYPE:
775
ADDRESS:4500 LINCOLN AVENUETELEPHONE:
(510) 531-3323
CITY:OAKLANDSTATE: CAZIP CODE:
94602
CAPACITY:100CENSUS: 25DATE:
10/14/2022
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Maureen Decoste, Executive DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medical attention was not sought for client in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/14/22 at 1:00pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced a subsequent complaint visit to investigate the above allegation. LPAs met with Executive Director (ED) and informed her the purpose of visit.

Allegation: Medical attention was not sought for client in a timely manner – Substantiated
The Department has investigated this allegation and per records review and interviews and found that client (C1) was a non-verbal client, when C1 complained chest pain and pointed to the hospital image on the device, staff performed temperature check, body check, and comforting R1; however, staff did not consult with health professional such as calling C1’s physician for medical advise or instruction, then sent C1 home. C1 was sent to hospital upon arriving home due to continuing complaining of chest pain, diagnosed a health condition change, and prescript a new medication in subject time period.

Continue on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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 15-AS-20220502111732
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: ABILITY NOW BAY AREA, INC.
FACILITY NUMBER: 011441112
VISIT DATE: 10/14/2022
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 information obtained, the preponderance of evidence is met, therefore the allegation is substantiated.

Deficiencies are cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with the ED.

Exit interview conducted with ED, LIC9099D, Appeal Rights, and copy this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20220502111732
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: ABILITY NOW BAY AREA, INC.
FACILITY NUMBER: 011441112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2022
Section Cited
CCR
82075(a)
1
2
3
4
5
6
7
82075 Health-Related Services
(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.
This requirement is not met as evidenced by…
1
2
3
4
5
6
7
Executive Director (ED) agrees to retrain staff and submits a self-certification of understanding regulation to CCL by the POC due day.

In addition, ED will submit training agenda with staff signatures to CCL by 10/21/2022.
8
9
10
11
12
13
14
Based on observation the licensee did not comply with the section cited above. LPA observed staff didn’t provide necessary needed medical service to client (C1) which posed an immediate health, safety or personal rights risk to persons in care.

8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Catherine Lin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3