019200734-4-3-2023-15-AS-HHUL-CRVPK3-20230516112224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200734
Report Date: 04/03/2023
Date Signed: 04/03/2023 12:36:50 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
07/29/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220729140627

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: 13	DATE:	04/03/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jovita Bansil, staff on duty		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Questionable death
Lack of supervision resulting resident sustained unexplained fractured leg while in care
Facility serves low quality food to residents
Facility does not provide planned activities for residents
Staff did not provide sufficient care for residents needs
Resident wheel chair is in disrepair

INVESTIGATION FINDINGS:

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On 4/3/2023 at around 9:35AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with S3 and explained the reason for the visit. LPA called Administrator Gurpreet Matharu and explained the purpose of the visit, Administrator stated that he is not available to meet LPA today and gave permission to LPA to discuss the report and provide a copy of the report to S3.

During the course of the investigation, the Department conducted interviews with staff, residents, health providers, and complainant. Medical records and facility file, incident report, and facility’s correspondence with health providers were obtained and reviewed.

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: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

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-20220729140627

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: 04/03/2023

NARRATIVE

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Allegation: Questionable death

Based on records review, On May 18, 2022, R1 was sent to the hospital due to leg pain, R1 was transferred then to a post-acute facility. Records review revealed that on 7/25/2022 R1 passed away with caused of death of vascular dementia.

Allegation: Lack of supervision resulting resident sustained unexplained fractured leg while in care

On August 16, 2022, department reviewed hospital medical records and records from the ambulance services (American Medical Response). On October 13, 2022, department conducted staff and resident interviews; licensee was interviewed via phone on January 17, 2023.

Based on interviews and record review, on May 18, 2022, at around 05:30AM Resident (R1) complaint of leg pain to the night staff but staff said there was no pattern in the way R1 was acting that prompted an emergency response. Staff (S1) stated R1 was normal because by 9AM, she changed her diaper without any issues or complaints. At around 01:42PM, R1 complaint of pain so staff called 9-1-1. Based on documents review, paramedics arrived and found R1 on supine position with no signs of distress. Medical records revealed that R1 was diagnosed of hip fracture with notes of unwitnessed fall, however it was not indicated the cause of injury and only noting that R1 had hip replacement surgery on 2012. R1’s Appraisal/Needs and Service Plan dated June 6, 2021, does not identify fall risk as an issue, R1 was non-ambulatory and wheelchair bound.

Allegation: Facility serves low quality food to residents

Based on interview and records review, facility has variety of food. LPA conducted interview with four residents (R2, R3, R4, & R7) in care, based on interview, and the residents are satisfied with the food that was being served,

Allegation: Facility does not provide planned activities for residents

Based on LPA’s observation and residents’ interview. Facility has a planned activities. During LPA’s visits, it was observed that staff are conducting different activities with the residents in care, at least 5-6 residents were observed to be attending the activities. Resident’s interview revealed that there are activities at the facility, however, sometimes residents want to join sometimes resident prefer to watch TV or stay in their rooms.

Allegation: Staff did not provide sufficient care for residents needs

Based on residents’ interview, facility is providing sufficient care for the residents. Residents stated that the staff are taking care of them and providing the care that they need.

Allegation: Resident wheelchair is in disrepair

Based on LPA’s observation on residents that are using wheelchairs. The wheelchairs was clean, functional and in good condition.

Based on the investigation, above allegations are deemed unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations 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: 04/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

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