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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200807
Report Date: 11/29/2023
Date Signed: 11/29/2023 03:22:58 PM


Document Has Been Signed on 11/29/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LLCFACILITY NUMBER:
019200807
ADMINISTRATOR:MARSHALL, SHIRLEYFACILITY TYPE:
740
ADDRESS:565 SCHAFER RDTELEPHONE:
(510) 398-8994
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:16CENSUS: 15DATE:
11/29/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH: Mandar Kulkarni TIME COMPLETED:
02:30 PM
NARRATIVE
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On 11/29/23 at 09:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a case management visit. LPA met with staff member Wyrek Fagin to address violations that were found during an investigation conducted by the Department. Administrator Sherley Marshall was called to be informed but was unable to come to the facility and Licensee Mandar Kulkarni was called and joined later.

During the course of the complaint investigation, Complaint Control No. 15-AS-20230522092645, the following additional information and deficiencies were identified.

Resident 2 (R2) was discovered to have had an unstageable pressure injury to his coccyx. R2 was sent to the hospital same day as R1 (05/18/2023), stating the facility could not provide the level of care that was needed for the wound. Staff (S2) interviewed acknowledged that she was caring for the wounds by copying what she had seen other home Health nurses do. S2 reported she has never received formal training on how to care for wounds.

Based on interviews and records review the facility did not report to the department that R1 and R2 developed pressure injuries and that R2 went to the hospital as a result of the pressure injuries.

Based on interviews and records review the facility did not report to R1 and R2’s families the residents change of condition of pressure injuries and hospital visits as a result of the pressure injuries. In an interview with Reporting Party (RP) they state that she and other family members visited on a regular visits and were not notified of the change in condition of the resident.

A $500.00 immediate civil penalty is assessed on this day. Licensee was informed that an additional civil penalty is still being determined based on Health & Safety Code 1569.49(f)

The following deficiency observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


Document Has Been Signed on 11/29/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
HSC
1569.269(a)(10)

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To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by:
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An immediate $500 civil penalty is assessed, and a mandatory meeting will be held at a later date.
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Based on the investigation, the licensee failed to comply with the section code cited above. R2 was observed to have an unstageable pressure injury to his coccyx. R2 was not sent to the hospital until May 18, 2023. This posed an immediate health and safety risks to resident in care.
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Type A
12/01/2023
Section Cited
CCR87631(a)(3)(A)

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Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound … care for the pressure injury from a physician or an appropriately skilled professional.This requirement was not met and evidenced by:
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A formal conference with CCLD will be scheduled at a later time.
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Based on the investigation, including interviews and records review, the licensee did not comply with the section cited above. Licensee retained 2 residents who required higher level of care, and both had unstageable wounds. This posed an immediate Health, Safety or Personal Rights risk to residents in care.
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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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/29/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
CCR
87211(a)(1)(B)

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Each licensee shall furnish to the licensing agency such reports as the Department ... A written report shall be submitted to the licensing agency ... This report shall include... Any serious injury as determined by the attending physician...
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mandatory meeting will be held at a later date.
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This requirement was not met and evidenced by: Based on interviews and records review, the facility did not report to the department that multiple residents developed pressure injuries
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Type A
12/01/2023
Section Cited
CCR87468.1(a)(8)

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Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care ... This requirement was not met and evidenced by:
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mandatory meeting will be held at a later date.
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Based on interviews and records review, the facility did not inform the residents representative/family about the residents’ change of condition
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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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 11/29/2023 03:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
CCR
87613(a)(2)(B)

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Prior to admission of a resident with a restricted health condition, the licensee shall: Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. Training shall be completed prior to the staff providing services to the residents.
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mandatory meeting will be held at a later date.
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This requirement is not met as evidence by: Staff stating has never received formal training on how to care for wounds and was mimicking what she saw Home Health do with other clients.
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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: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4