<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200816
Report Date: 11/04/2021
Date Signed: 11/04/2021 07:23:02 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
12/08/2020 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20201208133623
FACILITY NAME:SACRED HANDS LIVING IIFACILITY NUMBER:
079200816
ADMINISTRATOR:PANESAR, RAJWANT KFACILITY TYPE:
740
ADDRESS:3760 PINTAIL DRTELEPHONE:
(209) 762-2910
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
05:53 PM
MET WITH:Rajwant Panesar, AdministratorTIME COMPLETED:
06:54 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator(s) not at the facility for a sufficient amount of hours
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/04/21 at 4:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with administrator (ADM) to deliver the investigation findings. LPA explained the purpose of the visit with ADM.

Allegation: Administrator(s) not at the facility for a sufficient amount of hours.
Investigation Finding: Substantiated
Upon interview, the Licensee who serves as the Administrator indicated being the Administrator for 3 facilities and spending 2 hours per day at each facility. Therefore, the Licensee/Administrator is not meeting the requirement of being at the facility for 20 hours per week.

The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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 4
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
12/08/2020 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20201208133623

FACILITY NAME:SACRED HANDS LIVING IIFACILITY NUMBER:
079200816
ADMINISTRATOR:PANESAR, RAJWANT KFACILITY TYPE:
740
ADDRESS:3760 PINTAIL DRTELEPHONE:
(209) 762-2910
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:6CENSUS: 4DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
05:53 PM
MET WITH:Rajwant Panesar, AdministratorTIME COMPLETED:
06:54 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident(s) are not accorded privacy during conversations
Insufficient staff
Staff do not provide activities for residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/04/21 at 4:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with administrator (ADM) to deliver the investigation findings. LPA explained the purpose of the visit with ADM.

Allegation: Residents are not accorded privacy during conversation
Investigation Findings: Unsubstantiated
The Reporting Party asserted that the staff did not allow R1 to speak privately on the telephone. The facility stated that when given the telephone, R1 sometimes chose to sit in common areas and at other times went to her private room. Neutral witnesses who visited the facility on multiple occasions during the subject time period did not have observations pertaining to R1 speaking on the telephone.

Continued on next page, LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20201208133623
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: SACRED HANDS LIVING II
FACILITY NUMBER: 079200816
VISIT DATE: 11/04/2021
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: Insufficient Staff
Investigation Finding: Unsubstantiated

Upon records review and interviews, the RP asserted that during visits there was only 1 staff person present. The facility produced the staff schedule for the subject time period which illustrated a sufficient number of staff per the Appraisal Needs and Services available for the residents in care at the time. Neutral witnesses, including those who visited the facility in an official capacity, were unable to confirm the number of staff present during the subject time period. Although it was not possible to determine the sufficiency of staff present during the subject time period, during visit to the facility on 10/27/21 the Department found only 1 staff person present, which was not sufficient to meet the needs and services per the appraisals and Physician assessments for the residents in care. The facility is cited under a Case Management report dated 11/04/21.

Allegation: Staff do not provide activities for residents


Investigation Finding: Unsubstantiated
Per interviews, S1 stated that residents are encouraged by staff to engage in activities including gardening, walking around the inside of the facility & the backyard, watching television, reading, and games. This was corroborated by a resident who was identified as being mentally capable.

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

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

SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20201208133623
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: SACRED HANDS LIVING II
FACILITY NUMBER: 079200816
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2021
Section Cited
CCR
87405(a)
1
2
3
4
5
6
7
(a) The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section...
1
2
3
4
5
6
7
By POC date, administrator agreed to submit to CCLD a self certifcation that she has read, understood and will comply with Title 22 Section 87405 regulations.
8
9
10
11
12
13
14
This requirement was not met as evidenced by administrator not being at the facility for sufficient amount of hours which posed a potential health & safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4