075601424-12-4-2023-15-AS-KHOS-CYFLPV-20231212075633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601424
Report Date: 12/04/2023
Date Signed: 12/04/2023 11:01:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 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
09/05/2023 and conducted by Evaluator Paris Watson

COMPLAINT CONTROL NUMBER: 15-AS-20230905110825

FACILITY NAME:	AEGIS ASSISTED LIVING OF MORAGA		FACILITY NUMBER:	075601424
ADMINISTRATOR:	MARIA ANGELES STICKA		FACILITY TYPE:	740
ADDRESS:	950 COUNTRY CLUB DRIVE		TELEPHONE:	(925) 377-7900
CITY:	MORAGA	STATE: CA	ZIP CODE:	94556
CAPACITY:	100	CENSUS: 63	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ticarra Boyd, Care Director		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff do not provide proper incontinence care to residents in care
Staff do not provide proper medication assistance to residents in care
Facility is not kept clean
Facility is not kept free of pests

INVESTIGATION FINDINGS:

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On 12/04/2023 at 10:15 AM, Licensing Program Analyst P Watson arrived unannounced deliver findings for the above allegations. LPA met with Care Director, Ticarra Boyd and explain the purpose of the visit

During the course of the investigation the Department interviewed residents and staff and obtained documents. Documents including but not limited to: Staff roster with contact information, staff schedule for July, August and September, med tech training logs, resident roster, resident care plans, resident progress notes, MARS and LIC 622 for July, August and September, recent Physicians reports.

Report continues on 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris Watson	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230905110825

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: AEGIS ASSISTED LIVING OF MORAGA	FACILITY NUMBER: 075601424
	VISIT DATE: 12/04/2023

NARRATIVE

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It was alleged that Staff do not provide proper incontinence care to residents in care

Based on observations, LPA observed incontinence supplies in the memory care wings, LPA observed a sufficient amount of diapers, wipes and gloves. Based on interviews with staff (S1, S4 and S5), incontinence residents are checked on and changed every 2 hours. When asked about incontinence supplies, S4 and S5 stated that supplies can be low with Hospice residents due to limited supplies and wrong sizes. Based on interview with Care Director (CD), Hospice agencies send incontinence supplies weekly without CD needing to request. Other incontinence supplies are restocked by CD and placed in four different locations (in an unlocked cabinet in the Wellness Center, in a locked area/closet in each memory care wing and in an overstock closet that CD has access to).

It was alleged that Staff do not provide proper medication assistance to residents in care

Based on interview with CD, med techs (Medication Care Manager), the Associate Care Director, the Wellness Nurse and CD themselves dispense medication. There are seven med techs on staff, and five work during the day (two during AM shifts, two during PM shifts and one during NOC shifts). Based on interview with resident (R1), R1 has not experienced any issues with their medications. R1 stated that staff knocks on their door and dispenses their medications without issues.

It was alleged that Facility is not kept clean

Based on observations, LPA observed the facility to be clean and without odor. Housekeeping staff were observed cleaning the facility during the initial visit. Based on interviews with staff (S3, S4 and S5), the facility is kept clean. S4 stated that on average they observe housekeeping sanitation three times per their shift. Based on interview with Executive Director (ED), resident apartments are cleaned once a week, unless they have an accident and/or need it to be cleaned more frequently. The whole facility is cleaned every day by housekeeping.

Report continues on 9099 C

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris Watson	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20230905110825

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: AEGIS ASSISTED LIVING OF MORAGA	FACILITY NUMBER: 075601424
	VISIT DATE: 12/04/2023

NARRATIVE

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It was alleged that Facility is not kept free of pests

Based on observations, LPA did not observe any pests during the initial visit. Based on interviews with staff (S1 and S4), spiders are common in the memory care unit. S4 stated that they have observed spiders, roaches and stated that for some time there was a cricket in one of the hallways in the memory care wing. Based on interviews with Executive Director (ED) and Maintenance Manager (MM), the facility has a contract with Western Exterminator Company, the facility is inspected every month and treated as needed. Staff can report to MM when they observe pest, MM contacts the exterminator and the facility gets treated with the best mode to eliminate pest (such as traps and sprays).

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 725-7926
LICENSING EVALUATOR NAME: Paris Watson	TELEPHONE: (510) 622-2625
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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