079200775-10-9-2023-15-AS-KHOS-CWPHHB-20231017061227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200775
Report Date: 10/09/2023
Date Signed: 10/09/2023 02:41:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
10/02/2023 and conducted by Evaluator James Sampair

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20231002101429

FACILITY NAME:	BLUEGARDEN CARE		FACILITY NUMBER:	079200775
ADMINISTRATOR:	HUANG, YANLIN		FACILITY TYPE:	740
ADDRESS:	2729 MARSH DR		TELEPHONE:	(925) 208-1325
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	6	CENSUS: 2	DATE:	10/09/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Yanlin "Cynthia" Huang		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff left residents in soiled diapers for an extended period of time causing residents to sustain sores.
Staff does not feed residents in a timely manner.
Staff does not bathe residents in a timely manner.

INVESTIGATION FINDINGS:

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On 10/09/2023 at 10:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the initial 10-day complaint investigation of the allegations above. Upon entry, LPA informed Caregiver Evelia Galvan of the purpose of the visit, who informed Administrator (ADM) Yanlin "Cynthia" Huang. ADM arrived at approximately 11:15 AM.

During the visit, LPA reviewed facility and resident records, and interviewed 1 resident, 1 staff member, and ADM.

Staff left residents in soiled diapers for an extended period of time causing residents to sustain sores.
Based on the records review, interviews with residents and staff, there was no data supporting this allegation.

(Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

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-20231002101429

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BLUEGARDEN CARE	FACILITY NUMBER: 079200775
	VISIT DATE: 10/09/2023

NARRATIVE

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(...Continued from LIC9099)

Staff does not feed residents in a timely manner.
Based on the records review, interviews with residents and staff, there was no data supporting this allegation.

Staff does not bathe residents in a timely manner.
Based on the records review, interviews with residents and staff, there was no data supporting this allegation.

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

Exit interview was conducted with ADM. A copy of this report was provided via email.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC9099 (FAS) - (06/04)

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