019200744-8-27-2020-15-AS-HHUL-BSZ4DU-20200830190119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200744
Report Date: 08/27/2020
Date Signed: 08/27/2020 03:26:33 PM

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
06/26/2020 and conducted by Evaluator Treana White

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20200626152859

FACILITY NAME:	SACRED HANDS LIVING		FACILITY NUMBER:	019200744
ADMINISTRATOR:	PANESAR, RAJWANT		FACILITY TYPE:	740
ADDRESS:	2980 BLUMEN AVE		TELEPHONE:	(209) 762-2910
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	6	CENSUS: 5	DATE:	08/27/2020
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Rajwant Panesar, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure that resident was fed.
Medications are not adequately stored.

INVESTIGATION FINDINGS:

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On 08/27/2020, Licensing Program Analyst (LPA) T. White called the facility to deliver the complaint findings for the above allegations. LPA spoke with Administrator, Rajwant Panesar. LPA explained due to the present shelter in place order by the Governor, the notification of the complaint is being done over the phone.

During the course of investigation, LPA conducted interviews and obtained information in relation to the complaint. LPA interviewed 2 of 5 residents. Based on 2 of 5 resident interviews, the staff ensures that residents are fed. However, 3 of 5 residents were unavailable to be interviewed. There is not a preponderance of evidence to prove or disprove allegation.

Report continues on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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-20200626152859

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: SACRED HANDS LIVING	FACILITY NUMBER: 019200744
	VISIT DATE: 08/27/2020

NARRATIVE

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This agency has investigated the complaint alleging medications are not adequately stored. On 07/06/2020 tele-visit inspection, LPA observed medications are stored in locked food pantry. Staff #1 (S1) stated the key is locked in the kitchen drawer. S1 stated the key is relocated every week. However, based on conflicting information, residents are aware that the key is located in the kitchen drawer.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Administrator and a copy of report emailed to facility

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana White	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC9099 (FAS) - (06/04)

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