019200734-6-15-2022-15-AS-KHOS-CJ2M9Z-20220907092535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200734
Report Date: 06/15/2022
Date Signed: 06/15/2022 05:40:43 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
06/14/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20210614164530

FACILITY NAME:	JOY SENIOR CENTER		FACILITY NUMBER:	019200734
ADMINISTRATOR:	MATHARU, GURPREET		FACILITY TYPE:	740
ADDRESS:	6400 BRENTWOOD BLVD		TELEPHONE:	(510) 543-4695
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	18	CENSUS:	DATE:	06/15/2022
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Meledel Sumaylo, staff		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff left resident in soiled diapers for extended period of time resulting in pressure injuries
Staff are not meeting resident's hygiene needs
Staff did not notice residents decline in health
Staff are not meeting resident dietary needs

INVESTIGATION FINDINGS:

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On 6/15/2022, Licensing Program Analyst (LPA), L. Ibo arrived unannounced to investigate and deliver complaint findings of the above allegations. LPA met with S2 and explained the reason for the visit. LPA called Administrator Gurpreet Matharu, Administrator gave permission to LPA to provide copy of report to one of facility staff. LPA called Administrator to discuss and deliver findings.

LPA conducted interview with residents at the facility, based on the interview, residents are comfortable living at the facility, staff are helping residents with their needs.

Allegation: Staff left resident in soiled diapers for extended period of time resulting in pressure injuries; LPA reviewed daily logs it was indicated that residents was being change on regular basis however there were few times that residents refused to be change.

…Continue to lic9099c..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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-20210614164530

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: JOY SENIOR CENTER	FACILITY NUMBER: 019200734
	VISIT DATE: 06/15/2022

NARRATIVE

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Allegation : Staff are not meeting resident's hygiene needs; LPA reviewed residents records and logs, RP stated that R1 had dandruff, based on records review there was a dandruff shampoo ordered to address the issue, LPA interviewed staff, the staff stated and documented that staff offered to trim R1’s nails but residents refused staff assistance.

Allegation: Staff did not notice residents decline in health; LPA conducted records review, R1 was admitted at the facility on 11/2020 and left the facility on May 2021, there is no records of new needs and appraisal services regarding change of condition, staff does not recall any change in condition.

Allegation: Staff are not meeting resident dietary needs; LPA interviewed 6 residents, no concern of food, and residents stated that facility offer different kind of food, based on records review R1 do not have special dietary needs.

Based on all information gathered during the course of investigation, the allegations are close 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.

Exit interview conducted and copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

LIC9099 (FAS) - (06/04)

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