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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200877
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:50:34 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
12/12/2022 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20221212111307
FACILITY NAME:NATIONAL PSYCHIATRIC CARE AND REHAB SERVICES INCFACILITY NUMBER:
079200877
ADMINISTRATOR:CANDYCE PIRTLE-SMALLSFACILITY TYPE:
772
ADDRESS:2181 TICE VALLEY BLVDTELEPHONE:
(925) 478-3795
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94595
CAPACITY:12CENSUS: DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Candyce Pirtle-SmallsTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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- Staff administered unauthorized medication to a client while in care
- Staff did not provide the clients access to therapy services while in care
- Staff denied an authorized representative access to the facility
- Staff do not have planned activities for the clients
- Staff mishandled a client's medication while in care
INVESTIGATION FINDINGS:
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At 12:30 PM on 03/29/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced for a visit to deliver the findings concerning the allegations above. LPA explained the purpose of the visit with Administrator Candyce Pirtle-Smalls.

Over the course of the investigation, LPA J. Sampair reviewed client and facility records, interviewed 1 client, 2 staff members, and the Administrator.

Staff administered unauthorized medication to a client while in care
Interviews with the Administrator and staff S1 and a review of client C1's medication administration records and progress notes included no data that an unauthorized medication had been administered to client while in care.

CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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 2
Control Number 15-AS-20221212111307
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: NATIONAL PSYCHIATRIC CARE AND REHAB SERVICES INC
FACILITY NUMBER: 079200877
VISIT DATE: 03/29/2023
NARRATIVE
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... CONTINUED FROM LIC9099

Staff did not provide the clients access to therapy services while in care
An interview with staff S1 and a review of client C3 and C4's progress notes showed that access to therapy was provided to clients in care.

Staff denied an authorized representative access to the facility
Interviews with Administrator, staff S1, and a review of client C1's progress notes showed that the authorized representative identified had not been denied access to the facility.

Staff do not have planned activities for the clients
LPA observations of the facility, interviews with the Administrator and staff S1, and a review of the progress notes for clients C1, C2, C3 and C4 showed that there were planned activities for the clients.

Staff mishandled a client's medication while in care
Interviews with the Administrator, staff S2, review of client C1's medication administration records and progress notes included no data that staff had mishandled client's medication while in care.

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 via email.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2