079200248-5-16-2023-15-AS-BFOG-CRY63M-20230518202721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200248
Report Date: 05/16/2023
Date Signed: 05/16/2023 12:09:41 PM

Unsubstantiated

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
09/09/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210909154212

FACILITY NAME:	BLESSED CARE HOME		FACILITY NUMBER:	079200248
ADMINISTRATOR:	VICTORIA E. PALLERA		FACILITY TYPE:	735
ADDRESS:	72 RIVERVIEW DRIVE		TELEPHONE:	(925) 432-8047
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	6	CENSUS: 5	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Henry Magtibay, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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The administrator is not on the premises the number of hours necessary
Communications to the facility are not answered promptly
Staff do not provide meals of the quality and quantity necessary to meet the needs of the clients
Staff do not assist clients with medications as needed
Staff do not provide planned activities for the clients
Wheelchair ramp is in disrepair

INVESTIGATION FINDINGS:

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On 05/16/23 at 11AM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator to deliver the findings of above allegations. LPA explained the purpose of the visit with administrator.

Allegation: The Administrator is not on the premises the number of hours necessary
Investigation Finding: Unsubstantiated
During investigation, administrator (ADM) stated he lives at the facility along with the other staff (S1) 24/7 providing care and supervision to the 5 clients. ADM stated staff do not allow any client to cook food because of safety and fire hazards. ADM stated that on 09/09/21, he was out on errands and that another staff (S1) was available at the facility to care and supervise the clients while he was out. Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20210909154212

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: BLESSED CARE HOME	FACILITY NUMBER: 079200248
	VISIT DATE: 05/16/2023

NARRATIVE

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Allegation: The Administrator is not on the premises the number of hours necessary
Investigation Finding: Unsubstantiated
S1 stated she was busy clearing the backyard at the facility on 09/09/21 when the mental health agent visited. S1 stated she did not hear the doorbell when mental health agent was there. The clients did not bother to look for or inform S1 that the mental health agent was looking for her. The mental health agent left without speaking with S1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that the administrator is not on the premises the number of hours necessary is unsubstantiated.

Allegation: Communications to the facility are not answered promptly
Investigation Finding: Unsubstantiated
During investigation, Administrator stated staff always promptly answers phone calls at the facility. Review of FAS LIC 802 dated 09/09/21 show facility telephone number as 925-432-8047. Administrator (ADM) stated they always had facility telephone number 925-267-9162 since they were licensed on 04/11/11 and did not know the other telephone number existed. ADM also stated that he communicates with clients’ mental health agency by phone and by emails frequently. LPA observed ADM promptly answered the phone calls placed using 925-267-9162 during investigation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that communications to the facility are not answered promptly is unsubstantiated.

Allegation: Staff do not provide meals of the quality and quantity necessary to meet the needs of the clients

Investigation Finding: Unsubstantiated
During investigation, LPA observed 4 clients eating lunch in the dining area during visit. LPA observed sufficient food and drinks at the table for clients in care. LPA also observed fresh fruits (bananas, oranges, apples) available for clients to eat. LPA observed clients to be clean and comfortable in their surroundings. LPA observed 2 staff assisting clients with their meals. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not provide meals of the quality and quantity necessary to meet the needs of the clients is unsubstantiated.

Continued on next page, LIC 9099-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20210909154212

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: BLESSED CARE HOME	FACILITY NUMBER: 079200248
	VISIT DATE: 05/16/2023

NARRATIVE

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Allegation: Staff do not assist clients with medications as needed
Investigation Finding: Unsubstantiated
During investigation, clients confirmed with LPA that staff assist them with their daily medications. Review of random clients (C2, C5 & C6) Centrally stored medication logs and medication administration records show clients received assistance daily from staff in taking their prescribed medications. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not assist clients with medications as needed is unsubstantiated.

Allegation: Staff do not provide planned activities for the clients
Investigation Finding: Unsubstantiated
During investigation, clients (C2, C3, C5) confirmed with LPA that staff assisted them in shopping for clothes, buying food, going to parks & restaurants and making appointments for dental & medical care, During the pandemic, clients stated their day programs were closed. Clients stated they liked going out with friends and family most of the time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not provide planned activities for the clients is unsubstantiated.

Allegation: Wheelchair ramp is in disrepair
Investigation Finding: Unsubstantiated
During investigation, LPA observed the old wooden wheelchair ramp leading up to the front entrance is functional. LPA also observed additional supports installed by administrator to ensure ramp is safe and stable. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that wheelchair ramp is in disrepair is unsubstantiated.

Exit Interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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