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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200932
Report Date: 12/29/2023
Date Signed: 12/29/2023 11:00:14 AM

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
08/21/2023 and conducted by Evaluator Luisa Fontanilla
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230821153202
FACILITY NAME:MEGAN CARE HOMEFACILITY NUMBER:
079200932
ADMINISTRATOR:CHAUDHRY, TAYYABAFACILITY TYPE:
740
ADDRESS:118 MEGAN CTTELEPHONE:
(925) 433-6000
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY:6CENSUS: 5DATE:
12/29/2023
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Steven BagunasTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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9
Staff are over medicating the residents while in care
INVESTIGATION FINDINGS:
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On this day at around 10:30am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver finding for the above allegation and met with staff Steven Bagunas. LPA explained to Bagunas the purpose of the visit. The Administrator was informed over the telephone about the visit and she authorized Bagunas to sign the report.

During the course of investigation, LPA conducted interviews and reviewed records. On 8/24/2023, LPA initiated 10-day investigation, interviewed staff and two residents and obtained records.

Based on interviews and records reviews conducted, Resident 1 (R1) was admitted to the facility on August 10, 2023. On the same day, R1 was admitted to hospice care. A review of R1’s supplemental order from hospice indicates to discontinue all medications and start taking certain medications as ordered by hospice.

continuation on Lic 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
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-20230821153202
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: 12/29/2023
NARRATIVE
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On 8/24/2023, LPA interviewed R2 and R3 who both have Dementia and were not aware of what medications they take.

Based on interviews conducted with the Administrator and staff, they all denied over medicating the residents. All staff interviewed state they administer medications based on the doctor’s order. Based on interviews and record reviews conducted, the above allegation is 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 allegation is unsubstantiated.

There is no deficiency noted for this visit.

A copy of this report was provided to the Administrator.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2