079200580-1-26-2023-15-AS-HHUL-CP5N7Y-20230217091332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200580
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:55:47 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
10/26/2021 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20211026125822

FACILITY NAME:	HEATHERWOOD MEMORY CARE		FACILITY NUMBER:	079200580
ADMINISTRATOR:	FERNANDEZ, RYAN		FACILITY TYPE:	740
ADDRESS:	1315 MT PISGAH ROAD		TELEPHONE:	(925) 939-2833
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	32	CENSUS: 23	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ritchie Gonzales, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff abuses the residents with bruising
Staff is not assisting with incontinence care
The food service is inadequate
Staff is rough with the residents
Staff is rude to the residents
Resident's are not getting their showers
Staff not meeting training requirements
Staff is not administering medication according to doctor’s order

INVESTIGATION FINDINGS:

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On 1/26/2023 starting at 10:10 AM, Licensing Program Analysts (LPAs) L. Francisco and L. Alexander arrived unannounced to deliver findings for the above allegations. Upon arrival, LPAs met with Assistant Administrator, Katelyn Wilson. Administrator, Ritchie Gonazles later arrived at 10:30 AM.

During the course of the investigation, LPAs obtained information, reviewed records, collected documents, interviewed staff and residents. It was alleged staff abuses the residents with bruising. LPAs interviewed 6 staff and 2 residents, 6 of 6 staff and 2 of 2 residents denied staff abusing residents. 6 of 6 staff stated body checks are done when staff are changing residents and during showers. If any markings on residents body are observed by staff, then it is documented in the observation notes.

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: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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-20211026125822

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: HEATHERWOOD MEMORY CARE	FACILITY NUMBER: 079200580
	VISIT DATE: 01/26/2023

NARRATIVE

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It was alleged staff is not assisting with incontinence care. Based on interview with 6 staff, 6 of 6 staff stated residents are checked every 2 hours and changed as necessary. During LPAs visit on 1/26/2023, LPAs did not observe smell of urine or feces.

It was alleged the food service is inadequate. On 1/26/2023 at 1:30 PM, LPAs observed residents eating breaded chicken, broccoli and butternut squash for lunch. 6 of 6 staff stated residents are given 3 meals a day with 2 snacks and residents are allowed to ask for additional servings. 2 of 2 residents stated they are provided enough food.

It was alleged staff is rough with the residents. Based on interview with 6 staff and 2 residents, 6 of 6 staff and 2 of 2 residents denied allegation.

It was alleged staff is rude to the residents. Based on interview with 6 residents and 2 staff, 6 of 6 staff and 2 of 2 staff denied allegation.

It was alleged resident's are not getting their showers. However, based on interview, LPAs observed a shower schedule for all residents. According to 5 of 6 staff, if residents refused to shower, then staff will ask residents again. S1 stated if residents continues to refuse showering, then S1 will notify resident's family members and primary care physician.

It was alleged staff not meeting training requirements. However, LPAs reviewed a sample of 4 staff training records and 4 of 4 staff meets the training requirements.

It was alleged staff is not administering medication according to doctor’s order. Based on information obtained by complainant, bedtime medication is not being administered to residents because med-techs leave early. However, interview with S1, S2 and S6 revealed that residents with night time medications are given 30 minutes before the time indicated on the order. S1 stated there is a back-up NOC shift staff who is trained to pass medication if S2 and S6 are not available.

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

Exit interview conducted and a copy of this report provided to Administrator.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette Francisco	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

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