079200932-8-31-2023-15-AS-KHOS-CVKLM5-20230911085211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200932
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:57:26 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
08/14/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20230814102612

FACILITY NAME:	MEGAN CARE HOME		FACILITY NUMBER:	079200932
ADMINISTRATOR:	CHAUDHRY, TAYYABA		FACILITY TYPE:	740
ADDRESS:	118 MEGAN CT		TELEPHONE:	(925) 433-6000
CITY:	ALAMO	STATE: CA	ZIP CODE:	94507
CAPACITY:	6	CENSUS:	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	04:23 PM
MET WITH:			TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff do not answer residents' call light in a timely manner
Facility staff fail to assist residents with incontinence care
Insufficient staffing or lack of supervision

INVESTIGATION FINDINGS:

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On 8/31/23 at 4PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator to deliver the findings of above allegations. LPA explained the purpose of the visit with administrator.

Allegation: Staff do not answer residents’ call light in a timely manner
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed staff (S1, S2) and resident (R2) when resident (R1) resided at the facility on 08/10/23. R2 stated she woke up around 2AM due to R1 screaming for help. She stated S1 assisted R1, changed her diaper and gave her ice cubes and ice cream. R2 stated staff always assisted residents whenever the call button is used. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff do not answer residents’ call light in a timely manner is unsubstantiated. Continued on next page, LIC 9099-C

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: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230814102612

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: MEGAN CARE HOME	FACILITY NUMBER: 079200932
	VISIT DATE: 08/31/2023

NARRATIVE

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Allegation: Facility staff fail to assist residents with incontinence care
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed residents (R2, R6) who stated that staff change their diapers regularly (8AM, 12PM, 4PM, 7PM). R2 stated staff (S1, S2) work hard in assisting all residents with their daily needs. LPA observed residents (R2, R3, R4, R5, R6) were odor free, clean and well-groomed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility staff fail to assist residents with incontinence care is unsubstantiated.

Allegation: Insufficient staffing or lack of supervision

Investigation Finding: Unsubstantiated
During investigation, LPA interviewed residents (R2, R6) who stated staff are always there to assist them with their daily needs and would answer the call button when used. R2 stated staff work very hard in helping residents daily (AM, PM and night) and met her needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that facility has insufficient staffing or lack of supervision is 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: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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