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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002168
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:32:44 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20241022104212
FACILITY NAME:FERRER HOME CARE NO. 3FACILITY NUMBER:
045002168
ADMINISTRATOR:MABEL, MAXINEFACILITY TYPE:
735
ADDRESS:86 ARTESIA DRIVETELEPHONE:
(530) 342-9779
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:6CENSUS: 2DATE:
03/04/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:KILOTA MUALIATIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff mismanaged resident medication.
Staff do not ensure that resident needs are met.
INVESTIGATION FINDINGS:
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On 03/04/25 Donna Gurriere and Kayla Adkison, Licensing Program Analysts (LPAs) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 10/22/24. LPA Gurriere met with Kilota Mualia and explained the purpose of the visit.

Staff mismanaged resident medication.

During the interview process, the administrator and four staff persons were interviewed. Documents were obtained to include Medication Admission Records (MARs), Incident Reports, resident names and staff names and cell numbers.

continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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
Control Number 59-AS-20241022104212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: FERRER HOME CARE NO. 3
FACILITY NUMBER: 045002168
VISIT DATE: 03/04/2025
NARRATIVE
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During the investigation process, a visit was conducted to the facility and all medications were reviewed. Prescriptions are from Galt Pharmacy. Medications are pre-packaged and ready to dispense on a daily basis, including several time periods throughout the day. Centrally Stored Medication Log was present and current. Over-the-counter medications were logged and present.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Staff do not ensure that resident needs are met.

During the interview process, the administrator and four staff persons were interviewed. Documents were obtained to include Medication Admission Records (MARs), Incident Reports, resident names, staff names and cell numbers.

During the investigation process, staff were interviewed and overall reported that the residents’ needs are being met in several different ways to include assisted daily living skills. It was stated that there is awake staff during the nighttime to assist any of the residents during that time. It was reported that two residents attend a program and that the other two residents stay within the home during the day.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2