079200932-9-12-2023-15-AS-HHUL-CWRQAK-20231019120001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200932
Report Date: 09/12/2023
Date Signed: 09/12/2023 12:15:15 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
05/04/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230504165414

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: 4	DATE:	09/12/2023
		UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Melaine Rona, Caregiver		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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staff threatening resident
staff mocking residents
Staff member did not seek timely medical attention by calling 911 for a resident

INVESTIGATION FINDINGS:

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On 09/12/2023 at 11:21 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct an unannounced complaint visit. LPA met with caregiver Melaine Rona and explained the purpose of the visit. Administrator Tayyaba Chaudhry was called and Tayyaba agreed to have the care staff sign off on the report.

Based on interviews with staff and residents. The staff denied threatening the residents in care, staff denied hearing or witnessing any staff threatening the residents in care. Based on residents’ interview, three residents denied feeling threatened by staff, residents also denied hearing any staff threatened any residents in care.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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-20230504165414

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: 09/12/2023

NARRATIVE

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Continued from LIC 9099

Based on interviews the staff did call 911 from a mobile line but was redirected to an operator/queue because the call did not come from a land line. S1 was informed that a land line would get through quicker and S1 hung up and recalled on land line.

Based on interviews with staff and residents. The staff denied mocking the residents in care. LPA observed that staff treat residents with dignity. Spoke with staff and residents. It is unclear whether staff were mocking or condescending to the resident.

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

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

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