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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200807
Report Date: 03/29/2023
Date Signed: 03/29/2023 05:11:49 PM

Substantiated


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
03/24/2023 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230324083841
FACILITY NAME:CONTINUANCE CARE HOME LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 398-8994
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 14DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shirley MarshallTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Facility serving food that is not of quality.
Facility is not administering medications to resident as prescribed.
INVESTIGATION FINDINGS:
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On 3/29/2023 at 9 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct investigation on the above allegations. LPA met with Wyrek Fagin and explained purpose of the visit. Administrator Shirley Marshall arrived at a later time and left early for a prior appointment. Administrator authorized Wyrek to sign the report.

During the investigation, LPA reviewed resident records, Medication Administration Record (MAR), menus and interviewed 3 staff and 2 residents. LPA attempted to interview 2 other residents but was unsuccessful.

Based on medication review and interview conducted, Resident 1 (R1) was prescribed several medications which R1 was supposed to be taking effective 3/3/2023 but facility has not placed the order from the pharmacy.

LPA reviewed facility menu for the month of March 2023 and observed that dinner for 3/29/2023 indicates
"a bowl of soup and crackers." ***continuation on Lic 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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 5
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
03/24/2023 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230324083841

FACILITY NAME:CONTINUANCE CARE HOME LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 398-8994
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 14DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shirley MarshallTIME COMPLETED:
05:25 PM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Facility phone is inoperable.
INVESTIGATION FINDINGS:
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On this day at around 9 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct investigation on the above allegation. LPA was met by Wyrek Fagin. Administrator Shirley Marshall arrived at a later time but needed to leave early due to a prior appointment. Administrator authorized Wyrek to sign the report.

During the visit, LPA interviewed 4 staff and 2 residents. All staff interviewed state the facility phone is working except during the storm when the provider AT&T was having issues due to the weather. Otherwise, all residents are allowed use the phone and can take phone calls. Resident 3 (R3) states R3 is able to make calls and can take calls. However, R1 states otherwise.

While at the facility, LPA tried calling the phone and one of the staff answered the phone.

Due to conflicting information obtained during interviews, the above allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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 5
Control Number 15-AS-20230324083841
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: 03/29/2023
NARRATIVE
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Although the allegation 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 allegation is unsubstantiated.

There is no deficiency noted for the above allegation.

Exit interview was conducted with Wyrek and Appeal Rights was provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20230324083841
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: 03/29/2023
NARRATIVE
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For breakfast, menu indicates

Based on LPA Fontanilla's observations, interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22 deficiencies are being cited on the attached LIC 9099D.

Exit interview was conducted with Wyrek.

Appeal Rights and a copy of this report was provided to Wyrek
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20230324083841
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: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2023
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:
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By POC date, Administrator will order all the medications missing from the list and submit proof to CCL.
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(2) Once ordered by the physician the medication is given according to the physician's directions.
This requirement is not met as evidenced by:
The facility failed to comply with the regulation by failing to order medications for R1 which poses an immediate risk to health and safety of resident under care.
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Type B
04/28/2023
Section Cited
CCR
87555(a)
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General Food Service Requirements
(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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By POC date, facility will revise menu to meet the daily dietary needs of the residents and submit revised copy to CCL.
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This requirement is not met as evidenced by:
Based on LPA review of facility menu, facility failed to provide quantity and quality of food necessary to meet resident needs. March menu indicates "bowl of soup and crackers" for dinner.
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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: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5