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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200708
Report Date: 03/06/2024
Date Signed: 03/06/2024 01:34:53 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
02/29/2024 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20240229090259
FACILITY NAME:WATERMARK AT ROSEWOOD GARDENS, THEFACILITY NUMBER:
019200708
ADMINISTRATOR:ESPINOZA, CHELSEAFACILITY TYPE:
740
ADDRESS:35 FENTON STREETTELEPHONE:
(925) 443-7200
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:115CENSUS: 84DATE:
03/06/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Chelsea Espinosa, Administrator/Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff have not received required training prior to assisting with medications
INVESTIGATION FINDINGS:
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On 03/06/24 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM), gathered information and delivered investigation finding of above allegation. LPA explained the purpose of the visit with ADM.

During investigation, LPA interviewed staff (ADM, S2, S3) and obtained the following documents: Personnel record, Staff training/certifications records, resident roster, incident reports.

Continued on next page, LIC 9099-C


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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 2
Control Number 15-AS-20240229090259
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: WATERMARK AT ROSEWOOD GARDENS, THE
FACILITY NUMBER: 019200708
VISIT DATE: 03/06/2024
NARRATIVE
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Allegation: Facility staff have not received required training prior to assisting with medications
Investigation Finding: Unsubstantiated
During investigation, medication technicians' staff (S2, S3) confirmed with LPA that they completed all required medication administration training (shadowing & Relias trainings) prior to independently working as full time medication technicians. ADM stated that new medical technicians are required to complete 16 hours of medication administration on the job shadowing with experienced medical technicians. ADM stated each medical technician is also required to complete a Medication Pass Fundamentals Video Training which covers the safe preparation, security and proper administration of controlled substances, prescriptions and over the counter medications. Staff (S1) oversees the completion of each medical technicians' required on the job training and signs off on the medication pass certifications prior to releasing each new medical technician for work duty.

At 1PM, LPA reviewed staff (S1, S2, S3, S4, S5, S6) medication administration training records dated 01/01/23 to 03/01/24. LPA observed that all medical technicians completed their required job training certifications prior to working as full time medical technicians. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility staff have not received required training prior to assisting with medications is unsubstantiated.

No deficiencies observed during visit.

Exit Interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC9099 (FAS) - (06/04)
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