079200895-10-6-2023-15-AS-KHOS-CZ5HD7-20240103050550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200895
Report Date: 10/06/2023
Date Signed: 10/06/2023 05:44:06 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
09/08/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20230908113113

FACILITY NAME:	SACRED HANDS LIVING III		FACILITY NUMBER:	079200895
ADMINISTRATOR:	PANESAR, RAJWANT KAUR		FACILITY TYPE:	740
ADDRESS:	536 LAKE PARK CT		TELEPHONE:	(209) 762-2910
CITY:	OAKLEY	STATE: CA	ZIP CODE:	94561
CAPACITY:	6	CENSUS:	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Rajwant Panesar, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff restrained resident in their wheelchair.
Facility does not have sufficient staff to meet the needs of the residents.
Staff did not adequately supervise a resident, resulting in resident wandering out the front door of the facility.

INVESTIGATION FINDINGS:

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On 10/06/23 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Rajwant Panesar, Administrator, and explained the purpose of the visit.

During the course of investigation, LPA interviewed 2 staff. LPA was not able to interview any of the residents due to limited cognition and language barrier. LPA also reviewed staff schedules.

Staff restrained resident in their wheelchair: On 9/15/23 LPA observed R1 sitting at the dining room table. LPA did not observe R1 wearing a gait belt at that time. S1 showed LPA videos of the staff walking R1 using his gait belt. Staff state they never use the gait belt while R1 is sitting in his wheelchair.

***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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-20230908113113

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 III	FACILITY NUMBER: 079200895
	VISIT DATE: 10/06/2023

NARRATIVE

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***report continues from LIC9099***

Facility does not have sufficient staff to meet the needs of the residents: LPA reviewed staff schedules for August and September 2023. LPA observed that there are at least 2 staff on duty from 6am to 10pm 7 days a week.

Staff did not adequately supervise a resident, resulting in resident wandering out the front door of the facility: Based on staff interviews and observation there are no residents at the facility who exhibit wandering behavior.

This agency has investigated the complaints alleging staff restrained resident in their wheelchair, facility does not have sufficient staff to meet the needs of the residents, staff did not adequately supervise a resident, resulting in resident wandering out the front door of the facility. Based on LPA's observations and interviews which were conducted, we have found that the allegations were unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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