079200734-1-4-2024-15-AS-KHOS-CZASCV-20240108124609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200734
Report Date: 01/04/2024
Date Signed: 01/04/2024 12:16:33 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
11/21/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20231121122835

FACILITY NAME:	BAY CARE ASSISTED LIVING LLC		FACILITY NUMBER:	079200734
ADMINISTRATOR:	ONYEAGOCHA, ROSE C		FACILITY TYPE:	740
ADDRESS:	2352 SHANNON AVE		TELEPHONE:	(510) 964-1669
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	6	CENSUS: 4	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rose Onyeagocha, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not meeting resident's toileting needs
Staff do not keep the home clean or sanitary
Staff do not meet resident hygiene needs
Staff do not keep the facility free from odor
Staff are not providing residents adequate food service

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 01/04/24 at 10AM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver findings of above allegations. LPA explained the purpose of the visit with ADM.

Allegation: Staff are not meeting residents’ toileting needs
Finding: Unsubstantiated
During investigation, LPA observed staff assisting a resident with toileting and changing another resident inside her bedroom on 11/30/23. During visit, resident ‘s (R2) responsible party (F2) confirmed with LPA that he visits R2 every other day and has observed staff assist residents with their daily toileting needs, giving them showers, changing diapers, providing sufficient variety of meals and giving them prescribed medications. LPA observed staff take resident (R3) to the toilet on 01/04/24 at 11:45AM. Continued on next page, LIC-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 15-AS-20231121122835

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: BAY CARE ASSISTED LIVING LLC	FACILITY NUMBER: 079200734
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff do not keep the home clean or sanitary
Finding: Unsubstantiated
During investigation, LPA toured the facility with administrator (ADM) including but not limited to common living room, dining room, kitchen, bathrooms, residents' bedrooms, laundry closet and storage shed. LPA observed cleaning supplies (Clorox, Lysol, wipes) and detergent stored locked in the backyard storage shed. LPA also observed residents to be well-groomed, no urine or feces smells on them or inside their bedrooms. ADM stated staff clean and disinfect commonly touched surfaces with Clorox and Lysol every day. LPA observed the facility to be clean, odor free, sanitary and in good repair

Allegation: do not meet resident hygiene needs
Finding: Unsubstantiated
During investigation, R4 confirmed with LPA that staff change her diapers 3 or 4 times a day or as needed.
She stated that staff assist her with her hygiene needs (toileting, showering, grooming, dressing) each day. During visit on 11/30/23, LPA observed residents (R1, R2, R3, R4) to be clean, odor free and well groomed. free. ADM stated that staff checks on residents every 2 hours and changes their diapers as needed. LPA observed staff assisting resident (R3) in the toilet during visit while another staff was changing another resident (R4) inside her bedroom.

Allegation: Staff do not keep facility free from odor
Finding: Unsubstantiated
During investigation, LPA toured the facility with administrator (ADM) including but not limited to common living room, dining room, kitchen, bathrooms, residents' bedrooms, laundry closet and outside storage shed. LPA did not smell any foul odors inside or outside the facility. LPA did not observe any garbage or dirty laundry that may cause an odor. LPA observed the facility to be clean, odor free and in good repair. Continued on next page, LIC-9099C1

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20231121122835

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: BAY CARE ASSISTED LIVING LLC	FACILITY NUMBER: 079200734
	VISIT DATE: 01/04/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff are not providing residents adequate food service
Finding: Unsubstantiated
During investigation, LPA observed the facility has a minimum of 2-day perishable and 7-day non-perishable food supply including fresh fruits and vegetables, cereals, bread, juice, milk, water, coffee and meats stored in the kitchen refrigerator, freezer, pantry and garage refrigerator/freezer. On 11/30/23 at 12PM, LPA observed residents eating chicken stew, bread, fresh fruit with water & juice. LPA observed weekly menu showed a variety of meals scheduled from Monday to Sunday. Residents (R1, R4) and responsible party (F2) confirmed with LPA that staff provide a variety of food for breakfast, lunch, snacks and dinner with drinks every day. ADM stated residents are provided extra helpings of food and drinks upon request.

Based on records review, interviews conducted, and observations made, the department has investigated the above allegations and found them to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the above allegations are unsubstantiated.

No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy Panlilio	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3