015600562-5-31-2024-15-AS-BFOG-D66UMT-20240612154252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015600562
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:43:34 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, 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
03/22/2022 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20220322120903

FACILITY NAME:	MORNING SUN CARE HOME		FACILITY NUMBER:	015600562
ADMINISTRATOR:	GALANG, ROSARIO		FACILITY TYPE:	735
ADDRESS:	1502 171ST STREET		TELEPHONE:	(510) 481-9708
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	6	CENSUS: 6	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Maria Theresa 'Tek' Ordiniza/Assistant Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Resident (R1) was slapped while in care.

-Staff does not respond to facility telephone.

-Staff did not seek timely medical attention for a resident (R1).

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day, May 31, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations and close the complaint. LPA met with Maria Theresa 'Tek' Ordiniza, assistant ddministrator , and informed the reason for visit.

During the course of investigation, LPA reviewed resident's file, and obtained copies LIC9020 Register of Facility Clients/Residents and resident (R1) LIC602 Physician’s Report, Individual Program Plan (IPP) and LIC625 Appraisal/Needs and Services Plan.

LPA interviewed staff on 3/29/22 and 5/31/24. The residents (R1, R2, R3 and R4) were interviewed on 3/29/22 and 12/23/22, R1’s family member (FM) on 7/26/23, and R1’s case manager (CM) on 12/22/22.. LPA also reach out to the Police Records Unit for copy of police or incident/service report.

....continued on 9099C (page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20220322120903

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MORNING SUN CARE HOME	FACILITY NUMBER: 015600562
	VISIT DATE: 05/31/2024

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

Page 2

Allegation: Resident (R1) was slapped while in care.
It was alleged that a resident named Mike slapped R1 in the head on 3/08/22.

LPA interviewed R1 who stated he was hit in the head by R2 on 3/25/22 and the police came. LPA didn't observed any bruise or injury. All 3 staff and R4 confirmed police came; however all of them including R3 stated not observing R2 hit R1, and that there's no resident named Mike. LIC9020 showed no resident by the name of Mike. Due to diagnosis, LPA was not able to obtain information from R2 and R2's name is not Mike.

R1's case manager (CM) stated he spoke to the police about the hitting allegation and that the police said they visited the facility to do welfare check and R1 didn't say anything about what happened. Police indicated they didn't notice any injury. LPA reviewed the Special Incident Report (SIR) submitted by the facility which indicated no injury observed by the police officer.

Allegation: Staff does not respond to facility telephone.
It was alleged that staff keeps hanging up the phone when FM calls the facility and when FM is talking with R1. LPA interviewed FM who stated when she calls, the male staff listens and hangs up the phone. All staff interviewed denied the allegation. R1 stated when FM calls, the staff gives the phone to him and leaves his room.

Allegation: Staff did not seek timely medical attention for a resident (R!).
Reporting party stated that R1 got injured when R1 fell out of a bed at FM's place and landed on his head. It was alleged that R1 was hit on the side of the head where he got injured from fall incident.

CM stated that the police visited the facility to do welfare check and R1 didn't say anything about what happened. Police indicated they didn't notice any injury. LPA also observed no bruise nor injury when LPA interviewed R1. LPA also reach out to the Police Records Unit for copy of police or incident/service report but there's no record for the said incident. The staff interviewed also indicated no bruise observed when R1 alleged being hit by other resident. SIR indicated no injury observed by the police officer and that R1 refused to be sent out to be assessed.

.....continued on 9099C (page 3)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20220322120903

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MORNING SUN CARE HOME	FACILITY NUMBER: 015600562
	VISIT DATE: 05/31/2024

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

Page 3

Based on all information gathered, and LPA unable to obtain information from R2, all 3 allegations are closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited.

Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3