019200807-4-5-2021-15-AS-HHUL-BZUPZK-20210407114541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200807
Report Date: 04/05/2021
Date Signed: 04/05/2021 04:01:30 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
02/03/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20200203095430

FACILITY NAME:	CONTINUANCE CARE HOME LLC		FACILITY NUMBER:	019200807
ADMINISTRATOR:	MARSHALL, SHIRLEY		FACILITY TYPE:	740
ADDRESS:	565 SCHAFER RD		TELEPHONE:	(510) 684-6058
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	16	CENSUS: 9	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Shirley Marshall, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff engaged in verbal altercation in the presence of residents

Facility staff failed to provide a comfortable environment for residents in care

INVESTIGATION FINDINGS:

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Substantiated

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: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20200203095430

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: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
	VISIT DATE: 04/05/2021

NARRATIVE

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Continued from LIC9099.

On the allegation that facility staff failed to provide comfortable environment for residents in care. Based on resident statement the bedroom temperature was cold and the bathrooms are unsanitary. LPAs observed that 2 bathrooms did not have paper towel and 1 bathroom did not have toilet paper. LPAs observed that bedrooms were also used as storage and contained boxes of clothing and other items.

Based on LPA observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The following deficiencies were observed and cited (LIC 809-D) from California Code of Regulations, Title 22. Failure to correct and/ or repeat deficiencies within 12-month period may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

Page: 2 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
02/03/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20200203095430

FACILITY NAME:	CONTINUANCE CARE HOME LLC		FACILITY NUMBER:	019200807
ADMINISTRATOR:	MARSHALL, SHIRLEY		FACILITY TYPE:	740
ADDRESS:	565 SCHAFER RD		TELEPHONE:	(510) 684-6058
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	16	CENSUS:	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Shirley Marshall, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff does not allow resident to have visitors.

INVESTIGATION FINDINGS:

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On 04/05/2021 at 03:05pm, Licensing Program Analyst (LPA), L. Hall conducted an unannounced visit via telephone due to the present shelter-in-place order by the Governor. LPA spoke with Shirley Marshall, Administrator, and explained the reason for the call.

During the course of the investigation LPA reviewed the visitor log dated 12/13/19 – 2/5/2020 and interviewed residents. One resident stated there have been visitors, and one resident stated there are not any visitors, but not because the facility denies visitors.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted and a copy of this report provided.

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: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20200203095430

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: CONTINUANCE CARE HOME LLC	FACILITY NUMBER: 019200807
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/12/2021 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) ...elderly shall have all of the following personal rights: (2) To be accorded safe...comfortable accommodations, furnishings... This requirment was not met as evidence by:	1 2 3 4 5 6 7	Administrator agreed for all staff to have personal rights training to discuss both allegations. Proof training will be submitted to CCLD by POC date.
	8 9 10 11 12 13 14	Based on LPA interviews and observations Adminstrator did not comply with the section cited above which poses a potential health and safety risk to the clients in care.	8 9 10 11 12 13 14
Type B 04/12/2021 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a)... elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff... The requirement was not met as evidence by:	1 2 3 4 5 6 7	Same as above Plan of correction
	8 9 10 11 12 13 14	Based on LPA interviews and observations Adminstrator did not comply with the section cited above which poses a potential health and safety risk to the clients in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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