075601490-1-24-2024-15-AS-BFOG-CZU3GR-20240125171444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075601490
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:52:06 PM

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
08/01/2023 and conducted by Evaluator Lori Alexander-Washington

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230801143742

FACILITY NAME:	MAUREEN HOUSE		FACILITY NUMBER:	075601490
ADMINISTRATOR:	JOSE MICHAEL TORIO		FACILITY TYPE:	740
ADDRESS:	590 MAUREEN LANE		TELEPHONE:	(925) 818-6536
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	6	CENSUS: 6	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	04:40 PM
MET WITH:	Alberto Bernardino, Licensee		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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1. Staff inappropriately restrained resident.
2. Staff are unable to effectively communicate with residents due to language barrier.
3. Staff force residents to wear diapers.

INVESTIGATION FINDINGS:

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On 01/24/2024, at 4:40PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct complaint investigation visit for the above allegations. LPA met with Lea Robes and explained the reason for the visit. Licensee/Administrator, Alberto Bernardino, arrived shortly after.

Allegation: Staff inappropriately restrained resident.
Unsubstantiated.

On 08/03/2023 LPA called and spoke with RP. It was alleged that staff keeps R1 restrained in Lazy Boy chair and can't get up. LPA interviewed S2 that reported that R1 can get up with assistance. LPA observed R1 sitting in their chair without any restraints and observed S2 assisting R1 walking down the hallway to go to the restroom.

Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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-20230801143742

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: MAUREEN HOUSE	FACILITY NUMBER: 075601490
	VISIT DATE: 01/24/2024

NARRATIVE

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Allegation: Staff are unable to effectively communicate with residents due to language barrier. Unsubstantiated.

On 08/03/2023 LPA called and spoke with RP. It was alleged that staff are unable to communicate with residents. LPA interviewed S2 that stated that they are able to communicate with residents. LPA interviewed R5 that stated that the caregivers speak to each other in their own language. However, when they talk to the residents they speak in English and they can understand what their saying and have no problem with communicating.

Allegation: Staff force residents to wear diapers. Unsubstantiated.

On 08/03/2023 LPA called and spoke with RP. It was alleged that staff forces the residents to wear diapers. On 01/24/2024 LPA interviewed S2 that reported that all of the residents wear diapers because they are incontinent. LPA reviewed all of the residents (R1-R6) Physician's Reports and Appraisal/Needs and Services Plans which indicated incontinence.

Although the allegations may have happened or are valid, there is 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 was provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-Washington	TELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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