079200569-7-6-2020-15-AS-HHUL-BRDSZL-20200710141920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200569
Report Date: 07/06/2020
Date Signed: 07/06/2020 02:48:07 PM

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
02/01/2020 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20200201235324

FACILITY NAME:	PLEASANT HILL VILLA HOME CARE		FACILITY NUMBER:	079200569
ADMINISTRATOR:	MAGAT, GLICERIA M		FACILITY TYPE:	740
ADDRESS:	3021 PUTNAM BLVD		TELEPHONE:	(408) 933-8663
CITY:	PLEASANT HILL	STATE: CA	ZIP CODE:	94523
CAPACITY:	6	CENSUS: 5	DATE:	07/06/2020
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Gliceria Magat, Administrator/Licensee		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff serving expired foods to resident's.
Staff failed to provide an adequate amount of food to resident's.
Resident's are left in soiled diapers.
Staff not properly cleaning resident's.

INVESTIGATION FINDINGS:

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On 7/6/2020 at 2:20pm, Licensing Program Analyst (LPA) L. Francisco delivered findings for the above allegations via televisit due to shelter in place directed by the Governor. LPA spoke with Administrator/Licensee, Gliceria Magat.

During the course of investigation, LPAs inspected food supply, obtained information, collected documents and interviewed staff and residents. Based on information obtained, facility is serving expired food and not providing an adequate amount of food. On 2/7/2020 at 9:40am, LPAs inspected non-perishable and perishable food supply. LPAs did not observe any expired food. LPAs observed an ample amount of food such as vegetables, fruit, dairy and meat.

REPORT CONTINUES on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2020

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-20200201235324

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: PLEASANT HILL VILLA HOME CARE	FACILITY NUMBER: 079200569
	VISIT DATE: 07/06/2020

NARRATIVE

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Based on interviews with 3 of 4 staff, residents are prepared three (3) meals a day and given snacks in between. It was revealed during the interview that staff will provide more food upon resident’s request. Based on interview with R1, R1 said she receives enough food and is given “plenty of servings”.

Based on information obtained, residents are left in soiled diaper and not properly cleaned. An interview with 4 of 4 staff revealed that residents are checked every 2 hours or as needed. On 2/7/2020 starting at 9:40am, LPAs did not observe the smell of urine nor bowel movement in resident bedrooms. LPAs observed residents appeared to be well groomed. On 7/6/2020 at 2:25pm, S1 stated residents are given a shower two (2) times a week and are given a sponge bath twice a day on the other days. LPAs were unable to obtain additional information from other residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Administrator/Licensee over the phone. A copy of report will be emailed.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2020

LIC9099 (FAS) - (06/04)

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