019200744-4-7-2021-15-AS-HHUL-C29NX7-20210420105039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200744
Report Date: 04/07/2021
Date Signed: 04/07/2021 03:55:37 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
03/03/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20200303164416

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:	04/07/2021
		UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Rajwant Panesar, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility failed to meet regulatory requirements regarding resident refund.

Facility failed to provided proper meals to the residents.

Facility failed to sign an admission agreement prior to the resident moving into the facility.

INVESTIGATION FINDINGS:

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On 04/07/2021 at 03:40pm, Licensing Program Analyst (LPA), L. Hall had an unannounced tele-visit via telephone to deliver complaint findings on the above allegations: LPA spoke with Rajwant Panesar, Administrator and explained the reason for the call. LPA explained due to the present shelter-in-place order by the Governor, the complaint investigation is being done over the phone.
During the course of the investigation, LPA reviewed records, collected documents, interviewed 1 staff, 2 residents, and 2 witnesses. On the allegation that facility staff failed to meet regulatory requirements regarding resident’s refund. The facility provided text messages that showed communication between the witness and S1. Per text message from the W2 dated 01/19/2020, there was no timeframe for discharge. Per W2 belongings were retrieved on 01/20/20 or 01/21/20. Facility refunded a total amount of $3,166.00 to R1 on 02/21/2020 by cashier’s check.
Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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-20200303164416

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: 04/07/2021

NARRATIVE

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Continued from LIC9099.

On the allegation that facility failed to sign admission agreement prior to the resident moving into the facility. Per the regulation Title 22, Section 87507(c) the facility has seven (7) days for resident to sign the admission agreement

On the allegation that facility failed to provide proper meals to the residents. Both residents stated that they receive enough food to eat. Each day they receive three (3) meals plus snacks. If residents request more food, it is given.

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

Exit interview conducted and a copy of this report provided by email.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC9099 (FAS) - (06/04)

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