079200302-4-26-2023-15-AS-BFOG-CRAM4T-20230427091715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200302
Report Date: 03/16/2023
Date Signed: 04/26/2023 10:17:03 AM

Substantiated

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
09/26/2022 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20220926082823

FACILITY NAME:	STUART HOUSE, THE		FACILITY NUMBER:	079200302
ADMINISTRATOR:	PAMELA GREEN		FACILITY TYPE:	740
ADDRESS:	3067 BELFAST WAY		TELEPHONE:	(510) 262-0206
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94806
CAPACITY:	6	CENSUS: 4	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Jimmy Stuart, Co-Owner		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff denied resident phone calls
Staff denied resident visitors

INVESTIGATION FINDINGS:

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This is an amendment to the original 9099 dated 03/16/2023

On March 16, 2023, at 3::05PM, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced visit to deliver the findings on the above allegations and met with Co-Owner Jimmy Stuart and disclosed the purpose of the visit and was granted entry into the facility by Jimmy Stuart Co-Owner. 4 residents and 2 staff were present in the facility during this visit. The facility is a 4-bedroom 2-bath house.

During the course of the investigation the Department interviewed 1 staff, and Reporting Party (RP); obtained & reviewed the following documents for R1: physician reports, admission agreement, identification and emergency information, and Power of Attorney (POA). facility and staff roster were requested and received by CCLD via email on 10/03/2022.

Continue on LIC9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20220926082823

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: STUART HOUSE, THE	FACILITY NUMBER: 079200302
	VISIT DATE: 03/16/2023

NARRATIVE

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Continue from LIC 9099

Staff denied resident phone calls: SUBSTANTIATED

RP stated that R1 moved into the facility on August 20, 2022, RP called the facility to speak with R1 and first spoke with S1, RP stated that S1 wanted to know who she was because R1 kept asking for her. RP stated that she spoke with R1 and R1 sounded drugged. RP stated that S1 informed her that R1 could not have any visitors, calls or facetime for 30 days per her house rules during transition period. RP stated that she informed S1 that RP birthday is coming up within a few days and RP would like to see R1.

RP stated that when RP called the facility on 9/27/2022 S1 would not put R1 on the phone until W2 was connected to the call. RP stated that RP called the facility on 9/30/2022 at 3:00pm and 4:19pm there was no answer RP left a message and received a call back from S1 that informed her she needs to call between the hours of 10:00am and 4:00pm and R1 was not at the facility she was at a doctor appointment. RP stated that she made an appointment to visit R1 on 10/01/2022.

RP stated that RP called on scheduled day to make an appointment to visit, RP called at 12:00pm, 1:00pm and 3:48pm and left a message each time and there was no call back. RP stated that on 12/16/2022 RP called to schedule an appointment to visit and left a message with no call back.

RP stated that on March 10, 2023 RP call local law enforcement (Richmond Police Department) to conduct a welfare check because RP has not been able to reach R1 by phone since March 3, 2023.

Staff denied resident visitors: SUBSTANTIATED

RP stated that RP and W1 was parking outside of the facility and S1 came outside and informed them that they could not see R1 and R1 is in the facility eating cake. RP stated that they left flowers, a card and balloons for R1.

Continue on LIC9099

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20220926082823

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: STUART HOUSE, THE	FACILITY NUMBER: 079200302
	VISIT DATE: 03/16/2023

NARRATIVE

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Continue on LIC9099

Staff denied resident phone calls: SUBSTANTIATED

RP stated that on March 10, 2023 RP call local law enforcement (Richmond Police Department) to conduct a welfare check because RP has not been able to reach R1 by phone since March 3, 2023.

Staff denied resident visitors: SUBSTANTIATED

RP stated on 10/07/2022 RP was speaking with R1 and the phone got disconnected, RP stated she called back and the phone went to voicemail RP left a message stating that RP would call back after 1:00pm. RP stated that she called back at 2:57pm and reminded S1 that she has a scheduled visit and S1 stated she did not remember RP booking anything and the facility is booked, and she could come on Tuesday 10/10/2022. RP stated she could take R1 out so that RP would not interrupt the other visitors. S1 stated that she must speak with W3. RP stated that S1 stated that I do not have a court order. RP stated that she then told S1 that RP doesn’t need a order and the only time there is an order is when the court doesn’t want someone to take R1 out. RP asked S1 if she has an order. S1 refused to let RP take her out for a visit.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20220926082823

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: STUART HOUSE, THE	FACILITY NUMBER: 079200302
	VISIT DATE: 03/16/2023

NARRATIVE

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Continue from LIC9099C

RP stated that RP made an appointment to visit with R1 on 12/7/2022 with S1. On 12/6/2022 RP stated that she called the facility to inform S1 that she will be bringing someone with RP to visit. RP stated that she spoke with S2 and informed S2 that RP would be bringing someone with RP, RP stated that S2 stated S2 would inform S1. RP stated that RP received a phone call from S1 stating S2 didn’t inform S1 until the morning of 12/7/2022. RP stated that RP informed S1 that it’s not her fault S2 didn’t inform S1 RP was bringing someone to visit.

LPA interviewed S1, S1 stated W3 has power of attorney over medical and finances. S1 stated that she would like to speak to one of the siblings about R1’s health care and that person to inform the other siblings. S1 stated that R1 was not allowed to have any phone calls or visits with anyone for the first 30 days of moving into the facility, S1 stated this is so R1 could get acclimated to the facility and staff, S1 stated this is the facilities house rule, (which is not in writing or a part of the admissions agreement. Facility admission agreement visiting policy states family and friends are encouraged to visit anytime from 10:00am to 5:00pm). S1 made a schedule for R1’s children to call the facility and to also schedule appointments to visit R1 at the facility.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted and Plans of Correction were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20220926082823

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: STUART HOUSE, THE	FACILITY NUMBER: 079200302
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/24/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during... hours and without prior notice, provided that the rights of other residents are not infringed upon.	1 2 3 4 5 6 7	Administrator will read and understand regulation. Submit self certification to CCLD no later then the POC date.
	8 9 10 11 12 13 14	Based on LPA's observation licensee did not comply with the section cited above which poses a potential health and safety risk to clients.	8 9 10 11 12 13 14	Administrator will also add an addendum to the facilities Plan of Operation about residents visitors rights, to be submitted to CCLD no later then POC date.
Type B 04/24/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls.	1 2 3 4 5 6 7	Administrator will read and understand regulation. Submit self-certification to CCLD no later than the POC date.
	8 9 10 11 12 13 14	Based on LPA's observation licensee did not comply with the section cited above by restricting R1 phone calls with family which poses a potential health and safety risk to clients.	8 9 10 11 12 13 14

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: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: Carol Fowler	TELEPHONE: (510) 622-2715
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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