079200307-4-16-2024-15-AS-KHOS-D84NDL-20240813102232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200307
Report Date: 04/16/2024
Date Signed: 04/16/2024 02:52:40 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
01/18/2024 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20240118153636

FACILITY NAME:	CHRISJELL ADULT CARE SERVICES		FACILITY NUMBER:	079200307
ADMINISTRATOR:	ANNA LISA G. LAZARO		FACILITY TYPE:	735
ADDRESS:	748 SEACLIFF COURT		TELEPHONE:	(510) 541-5234
CITY:	RODEO	STATE: CA	ZIP CODE:	94572
CAPACITY:	6	CENSUS: 6	DATE:	04/16/2024
		UNANNOUNCED	TIME BEGAN:	02:46 PM
MET WITH:	ANA LISA LAZARO, ADMINISTRATOR		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff are not meeting client's personal care needs

INVESTIGATION FINDINGS:

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On 04/15/2024 at 2:45PM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with Anna Lisa Lazaro, Administrator and explained the reason for the visit.

During the course of the investigation, the Department conducted interviews with Staff 1 (S1) Witness 1 (W1) Reporting Party (RP) and Client 1 (C1) and reviewed the resident records. LPA received a copy of C1's Individual Service Plan (ISP) Physicians Report (LIC 602), LIC500, Medication List and Salon/Spa Receipts, Administrator copy of email to C1’s doctor dated 9/2/2020 and LIC9020.

CONTINUE ON LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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-20240118153636

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: CHRISJELL ADULT CARE SERVICES	FACILITY NUMBER: 079200307
	VISIT DATE: 04/16/2024

NARRATIVE

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CONTINUE FROM LIC9099

Allegation: Staff are not meeting client's personal care needs
Investigation Finding: unsubstantiated.

RP reported that RP witnessed C1 limping in pain and requested to see C1’s feet. RP reported that C1 had overgrown and curling toenails with skin discoloring and one toenail split, RP stated C1 was in pain. RP also stated that C1s shoes were hurting C1s feet and C1 socks had a whole in them. LPA Interviewed S1 and it was revealed that C1 has a diagnosis which a couple of the side effects are athlete’s foot and fungal infection which is common with C1 diagnosis. LPA was provided information from Precision Foot and Ankle Centers web address. S1 also informed LPA that it was hard to get an appointment during the holiday season for C1 pedicure. C1 was also excited to visit with C1’s family, C1 was excited and distracted and refused to go to his regular visit to the foot spa/salon, which is scheduled each month, for fear C1 would miss the visit with C1’s family. S1 also stated that during C1’s visit with W1. C1 returned to the facility with a pair of orange shoes for C1, W1 bought for C1 which was too small for C1. C1 was wearing the orange shoes the day C1 complained of foot pain. LPA interviewed C1 and it was revealed that C1 understands that the orange shoes are too small, and they hurt. C1 stated that C1 family member bought the orange shoes for C1 and they became C1s favorite pair of shoes. C1 stated that C1 feet are not hurting, LPA observed C1 wearing a different pair of shoes. LPA observed C1’s toenails and fingernails which were manicured on 01/18/2024 both fingernails and toenails still had discoloration. LPA interviewed W1 and W1 was not aware that the shoes W1 purchased for C1 were too small. W1 stated that W1 will buy C1 a new larger size shoe. W1 stated that C1 has been living at the facility for a long time and W1 felt that the facility takes good care of C1 and it’s a good facility. Therefore, this allegation is unsubstantiated.

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 are not meeting client's personal care needs is unsubstantiated.

No deficiencies observed during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC9099 (FAS) - (06/04)

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