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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200807
Report Date: 08/12/2020
Date Signed: 08/12/2020 05:00:47 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
05/06/2020 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20200506123417
FACILITY NAME:CONTINUANCE CARE HOME LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 684-6058
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 9DATE:
08/12/2020
UNANNOUNCEDTIME BEGAN:
11:13 PM
MET WITH:Shirley Marshall, AdministratorTIME COMPLETED:
11:44 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to provide care and supervision to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/12/20 at 11:13 PM, Licensing Program Analyst (LPA) conducted a subsequent Facetime tele-visit with Administrator Shirley Marshall to discuss above allegation and deliver finding. Due to COVID 19 shelter in place order issued by the Governor, Administrator was not physically available to sign this report.

Based on LPA's interviews and record reviews, Administrator and staff provided care and supervision to R1 such as bathing, showering, dressing, grooming, transferring from bed to wheelchair and meals. LPA also reviewed several hospital discharge records on R1 for urinary tract infections (UTI) while in care at the facility. Administrator explained that R1 would refuse care from staff on several occasions and would constantly call 911 to be sent to the hospital for treatment. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited. Exit Interview conducted and a copy of this report provided to Administrator via email.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
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 2
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
05/06/2020 and conducted by Evaluator Daisy Panlilio
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20200506123417

FACILITY NAME:CONTINUANCE CARE HOME LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 684-6058
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 9DATE:
08/12/2020
UNANNOUNCEDTIME BEGAN:
11:13 PM
MET WITH:Shirley Marshall, AdministratorTIME COMPLETED:
11:44 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to assist resident secure Medi-Cal coverage
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/12/20 at 11:13 PM, Licensing Program Analyst (LPA) conducted a subsequent Facetime tele-visit with Administrator Shirley Marshall to discuss above allegation and deliver finding. Due to COVID 19 shelter in place order issued by the Governor, Administrator was not physically available to sign this report.

Based on LPA's interviews with Administrator and W1, Administrator scheduled a meeting with W1 and a notary public on 5/23/20 to complete R1's Medi-Cal and guardianship paperwork at the facility. Due to R1's hospitalization on the same day, the meeting was cancelled. Administrator was not able to reschedule the meeting due to W1's other personal commitments. W1 confirmed this LPA This department had investigated the complaint alleging that facility staff failed to assist resident secure Medi-Cal coverage. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. No deficiencies cited. Exit Interview conducted and a copy of this report provided to administrator via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Rajind BasiTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
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 2