019200744-10-1-2020-15-AS-KHOS-BU5LVU-20201006090606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200744
Report Date: 10/01/2020
Date Signed: 10/01/2020 04:06:19 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
03/20/2020 and conducted by Evaluator Celia Phomphachanh

COMPLAINT CONTROL NUMBER: 15-AS-20200320141931

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: 6	DATE:	10/01/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rajwant Panesar, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Residents are not getting their needs met.
Staff are not taking resident special diet into consideration.
Food supply is inadequate.
Food is not warmed up properly.
Facility temperature is uncomfortable for residents.

INVESTIGATION FINDINGS:

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On Thursday, October 1, 2020 at 1: 00 PM, Licensing Program Analyst (LPA) C. Phomphachanh conducted unannounced call to deliver findings on 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 the investigation, LPA interviewed staff (S1-S3), witnesses (W1-W2), and residents (R1-R6). In addition, LPA conduct 2 tele-visits unannounced to observe facility and residents on 06/29/2020 and 08/20/2020. When LPA contacted Reporting Party (RP), RP did not want to be interviewed or contacted again.

For the allegation, residents are not getting their needs met. LPA interviewed 6 current residents at the facility. All 6 residents indicated that their needs are being met during tele-visit with LPA on 10/01/2020. Therefore, this allegation is unsubstantiated.

Continuation on LIC 9099 C - Page 1 of 2 Complaint Investigation Report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Celia Phomphachanh	TELEPHONE: (510)286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

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 4

Control Number 15-AS-20200320141931

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: 10/01/2020

NARRATIVE

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Continuation Page 2 of 2 - Complaint Investigation Report

For the allegation, staff not taking resident special diet into consideration. LPA interviewed S1-S3, staff stated no resident is on a special diet. Facility has pre-schedule breakfast, lunch, and dinner list on a monthly calendar. Staff will feed resident and if request, staff food on the daily menu and will provide what the resident ask for if available. LPA interviewed 6 current residents, residents did not have any issue on food or is on a special diet. LPA interviewed previous residents, no issues either. Therefore, this allegation is unsubstantiated.

For the allegation, food supply is inadequate. LPA conducted 2 unannounced tele-visit on 06/29/2020 and 08/20/2020 to tour and observed facility. Facility does have ample amount of food supply for perishable and nonperishable in the kitchen, additionally food supply were stored in the garage with 1 refrigerator, 1 freezer, and nonperishable were on shelves and locked cabinets. Therefore, this allegation is unsubstantiated.

For the allegation, food not warmed up properly. LPA observed facility during tele-visit, facility does have microwave and oven to properly warm food. LPA interviewed 6 residents about warming food, all residents have no issue. When LPA interviewed witnesses (W1-W2), 1 of 2 witnesses had an issue with food still cold after being warmed. LPA interviewed staff about foods not being warm properly, all staff agree that if food was cold and resident needed the food to be warm, there would be no issue to have the food warm again. Therefore, there is not a preponderance of evidence to prove or disprove this allegation. It is unsubstantiated.

For the allegation, facility temperature is uncomfortable for residents. During a tele-visit, LPA observed the thermostat to be locked and kept at 73 degrees Fahrenheit (F) which is within Community Care Regulations 87303 under Maintenance and Operation requires a minimum of 68 degrees F. Facility meets a comfortable temperature for residents. Therefore, this allegation is unsubstantiated.

Based on interviews conducted and observations, LPA has found these allegations to be UNSUBSTANTIATED.
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.

Exit interview conducted with Administrator, Rajwant Panesar, and a copy of report emailed PDF file to facility.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Celia Phomphachanh	TELEPHONE: (510)286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
03/20/2020 and conducted by Evaluator Celia Phomphachanh

COMPLAINT CONTROL NUMBER: 15-AS-20200320141931

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: 6	DATE:	10/01/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rajwant Panesar, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Provider asks staff to lie to the licensing agency.
Medications are not administered as prescribed.
Shower is not working.

INVESTIGATION FINDINGS:

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On Thursday, October 1, 2020 at 1: 00 PM, Licensing Program Analyst (LPA) C. Phomphachanh conducted unannounced call to deliver findings on 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 the investigation, LPA interviewed staff (S1-S3), witnesses (W1-W2), and residents (R1-R6). In addition, LPA conduct 2 tele-visits unannounced to observe facility and residents on 06/29/2020 and 08/20/2020. When LPA contacted Reporting Party (RP), RP did not want to be interviewed or contacted again.

For the allegation, provider asks staff to lie to the licensing agency. LPA interviewed S3, S3 denied the allegation.
LPA was not able to interview Reporting Party. LPA interviewed R1-R6, all residents denied the allegation. LPA interviewed Administrator, Administrator also denied the allegation. There is not a preponderance of evidence to prove or disprove this allegation, therefore, it is unsubstantiated.

Continued on LIC 9099C -Page 1 of 2 - Complaint Investigation Report

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Celia Phomphachanh	TELEPHONE: (510)286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20200320141931

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: 10/01/2020

NARRATIVE

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Continued Page 2 of 2 - Complaint Investigation

For the allegation, medications are not administered as prescribed. LPA asked S1 for the protocol for administering medications, S1 stated, "Medications are locked in a closet. Each resident has a closed small tupperware. Residents do not take their own medications. It is given by the caregiver." LPA interviewed S3, S3 indicated that S3 provide medications by prescribed physician order and identifying the names of residents. LPA was not able to conduct interview with RP regarding this allegation. All residents interviewed, residents did not have any issues with medications being given by care staff. There is not a preponderance of evidence to prove or disprove this allegation, therefore, it is unsubstantiated.

For the allegation, shower is not working. LPA conducted tele-visit on 03/26/2020 initial 10-day, 06/29/2020. and 08/20/2020; all bathroom showers were operable. LPA observed during tele-visit, facility has 2 full bathrooms with showers. Master bathroom has separate shower and tub,other bathroom has combined shower/tub. LPA interviewed S1 about showering not working. S1 stated that one shower was clogged up and plumber was contacted immediately. While one of the showers were not working, facility had additional showers for residents. Therefore, this allegation is unsubstantiated.

Based on interviews conducted and observations, LPA has found these allegations to be UNSUBSTANTIATED.
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.

Exit interview conducted with Administrator, Rajwant Panesar, and a copy of report emailed PDF file to facility.

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (510) 286-0518
LICENSING EVALUATOR NAME: Celia Phomphachanh	TELEPHONE: (510)286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 4