015601410-8-23-2023-15-AS-KHOS-CVCQDY-20230904120530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601410
Report Date: 08/23/2023
Date Signed: 08/23/2023 07:26:14 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
03/24/2022 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20220324113028

FACILITY NAME:	ARCADIAN RESIDENTIAL COMMUNITY		FACILITY NUMBER:	015601410
ADMINISTRATOR:	LULIN WU		FACILITY TYPE:	740
ADDRESS:	24647 MOHR DRIVE		TELEPHONE:	(510) 887-8898
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	40	CENSUS: 39	DATE:	08/23/2023
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Lulin Wu/Administrator		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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-Staff are not meeting resident's needs.

-Staff are not providing adequate food service to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations, and close the complaint. LPA met with Lulin 'Lucy' Wu, administrator, and informed the reason for visit.

During the course of investigation, LPA reviewed residents file, and inspected the food supplies. LPA reviewed residents records, and obtained copies of the following documents: LIC601 Identification and Emergency Contact Information; LIC602A Physician's Report; Appraisal. LPA interviewed staff (administrator and S1), licensees and residents on 3/30/22 and 8/31/22.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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 5

Control Number 15-AS-20220324113028

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: ARCADIAN RESIDENTIAL COMMUNITY	FACILITY NUMBER: 015601410
	VISIT DATE: 08/23/2023

NARRATIVE

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Page 2

Allegation: Staff are not meeting residents’ needs.
It was alleged that there is a resident who screams like this resident is in pain 24/7. It was further alleged this resident may have a flesh-eating bacterium from not getting the diaper changed enough making this resident screams day and night.

When LPA arrived to the facility on 3/20/22, LPA heard a resident crying and learned that this resident is R5, LPA observed staff went to R5's room and calmed R5 down. Administrator and licensees Wendy Wong and Olive Manalastas stated that R5 has screaming, crying and yelling behaviors. Review of R5's records confirmed administrator and licensees' statements. Administrator stated R5 is on hospice and that they were working with the hospice agency to address the behaviors. S1 confirmed that facility had worked with the hospice agency and R5's medications were adjusted to address the medications. During visits on 8/31/22 and 8/23/23, LPA no longer heard R5 crying or screaming.

On 3/30/22, 8/31/22 and 8/23/23, LPA observed R5 clean and no smell of urine.

Five residents were interviewed on 3/30/22 and 8/31/22. R1 indicated that the only time she does not hear R5 cries is when she (R1) goes to sleep. Three residents stated they are not bothered by R5's crying and two of these 3 residents stated it's R5's behavior. LPA was not able to obtain information from R5 and 1 of the other residents.

Based on information gathered and LPA unable to obtain information from R5, the allegation of staff are not meeting resident's needs is closed as unsubstantiated. A finding that the complaint 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.

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

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 15-AS-20220324113028

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: ARCADIAN RESIDENTIAL COMMUNITY	FACILITY NUMBER: 015601410
	VISIT DATE: 08/23/2023

NARRATIVE

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Page 3

Allegation: Staff are not providing adequate food service to resident.
It was alleged that resident (R1) is a vegan and the facility keeps giving R1 meat and food with gluten.

LPA interviewed R1 who stated she has food allergy and needs super foods but has not told the staff of her food preferences. Administrator stated R1 likes tofu & fruits which the facility provides. Administrator also stated R1 likes organic food so the staff drive R1 to the store so R1 can buy the organic items she prefers. The other 4 residents interviewed indicated they like the food facility serves. Review of R1's record showed R1 is interested in organic farming. R1's LIC602A Physician's Report didn't indicate R1 being vegan, having food allergy or on special diet.

LPA inspected the food supplies which were observed of different varieties.

Based on information gathered, the allegation of staff are not providing adequate food service to resident is closed as unsubstantiated. A finding that the complaint 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.

No deficiency cited.

Exit interview conducted, and copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
03/24/2022 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20220324113028

FACILITY NAME:	ARCADIAN RESIDENTIAL COMMUNITY		FACILITY NUMBER:	015601410
ADMINISTRATOR:	LULIN WU		FACILITY TYPE:	740
ADDRESS:	24647 MOHR DRIVE		TELEPHONE:	(510) 887-8898
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94545
CAPACITY:	40	CENSUS: 39	DATE:	08/23/2023
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Lulin Wu/Administrator		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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Facility tap water is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations and close the complaint. LPA met with Lulin 'Lucy' Wu, administrator, and informed the reason for visit.

During the course of investigation, LPA conducted inspection and interviewed staff, licensee and residents.

It was alleged that something is wrong with the tap water, and that the water and sewer pipelines are merging.

....continued on 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 15-AS-20220324113028

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: ARCADIAN RESIDENTIAL COMMUNITY	FACILITY NUMBER: 015601410
	VISIT DATE: 08/23/2023

NARRATIVE

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LPA conducted inspection on 3/20/22 and 8/31/22 and didn't observe any broken pipes. Facility was observed to have running water. LPA checked the tap water and observed it clear and no residue. Licensee and administrator stated they was no incident of water and sewer pipes being in disrepair or damaged. All 4 residents interviewed indicated there's no problem or issue with water.

Based on information obtained, the allegation is closed as unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiency cited.

Exit interview conducted, and copy of this report provided

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Alicia Delmundo	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5