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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079200932
Report Date: 10/02/2024
Date Signed: 10/14/2024 02:58:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
03/01/2024 and conducted by Evaluator Alona Gomez
COMPLAINT CONTROL NUMBER: 15-AS-20240301121209
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: 6DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Tayyaba ChaudhryTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are allowing a resident to wear other residents clothing
INVESTIGATION FINDINGS:
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On 10/02/2024 at 9:30 a.m., Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a complaint investigation in regard to the allegations above. LPA met with Caregiver, Melanie Rona and explained the purpose of the visit. LPA spoke with Administrator over the phone who stated they had an appointment and would come by later to sign the report. Administrator arrived at 10:45 am.

LPA interviewed staff and found that there have been times when residents were wering other residents clothes because of a mix up with laundry. Staff stated that sometimes the mix up does not get fixed for about a week because it goes unoticed. Therefore the allegation of "Staff are allowing a resident to wear other residents clothing" is substantiated.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
03/01/2024 and conducted by Evaluator Alona Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240301121209

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: 6DATE:
10/02/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Tayyaba Chaudhry TIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff do not meet a resident's dietary needs
Staff do not provide adequate food service to the residents
Staff did not prevent a resident from getting injured while in bed
Staff mishandled a resident's medication
Staff do not have planned activities for a resident
Staff allow a resident to consume alcohol without proper authorization
Staff are not properly trained to handle a resident with dementia
Staff are not notifying authorized representative of incidents involving a resident
INVESTIGATION FINDINGS:
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On 10/02/2024 at 9:30 a.m., Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a complaint investigation in regard to the allegations above. LPA met with Caregiver, Melanie Rona and explained the purpose of the visit. LPA spoke with Administrator over the phone who stated they had an appointment and would come by later to sign the report. Administrator arrived at 10:45 am.

On the allegation of "Staff do not meet a resident's dietary needs" LPA observed residents getting specialized meals. LPA also interviewed staff and found that residents meals are modified based on their needs and preferences therefore the allegation of "Staff do not meet a resident's dietary needs " is UNSUBSTANTIATED.

Report continues on LIC9099-C PAGE 1
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20240301121209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MEGAN CARE HOME
FACILITY NUMBER: 079200932
VISIT DATE: 10/02/2024
NARRATIVE
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PAGE 1

On the allegation of "Staff do not provide adequate food service to the residents" LPA interviewed staff and found that staff cook 3 square meals a day and provide snacks. LPA also observed plenty of food available to residents during each visit. Administrator also provided photos of residents meals throughout the months therefore the allegation of "Staff do not provide adequate food service to the residents" is UNSUBSTANTIATED.

On the allegation of "Staff did not prevent a resident from getting injured while in bed" LPA interviewed staff and discussed how when residents are agitated in bed they provide comfort as well as any prescribed medications as needed. LPA also conducted a collateral visit where they found that R1 can become agitated and bruises easily due to a condition therefore the allegation of "Staff did not prevent a resident from getting injured while in bed" is UNSUBSTANTIATED.

On the allegation of "Staff mishandled a resident's medication" LPA interviewed staff and was not able to identify a time when medication was distributed inappropriately. LPA also obtained copies of the MAR that were complete and accurate. LPA also viewed the current MAR that was complete and up to date therefore the allegation of "Staff mishandled a resident's medication" is UNSUBSTANTIATED.

On the allegation of "Staff do not have planned activities for a resident" LPA interviewed staff and found that they do daily activities with residents such as walking or puzzles. LPA also observed a variety of activities available to the residents. Administrator also showed LPA photos of residents engaging in activities at the facility throughout the year therefore the allegation of "Staff do not have planned activities for a resident" is UNSUBSTANTIATED.

On the allegation of "Staff allow a resident to consume alcohol without proper authorization" LPA interviewed staff and found that residents are never allowed to consume alcohol and that any alcohol brought into the facility is for the live in caregivers and is stored in the garage out of residents availability. LPA did not observe any alcohol accessible during visits therefore the allegation of "Staff allow a resident to consume alcohol without proper authorization" is UNSUBSTANTIATED.

REPORT CONTINUES ON LIC9099-C PG 2
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20240301121209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: MEGAN CARE HOME
FACILITY NUMBER: 079200932
VISIT DATE: 10/02/2024
NARRATIVE
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CONTINUED PAGE 2
On the allegation of "Staff are not properly trained to handle a resident with dementia" LPA observed that all staff are up to date on their training's therefore the allegation of "Staff are not properly trained to handle a resident with dementia" is UNSUBSTANTIATED.

On the allegation of "Staff are not notifying authorized representative of incidents involving a resident" LPA observed that Administrator had a record of all incident reports. Administrator also showed text message communications of daily life and updates to residents families including R1 therefore the allegation of "Staff are not notifying authorized representative of incidents involving a resident" is UNSUBSTANTIATED.

Although the allegations 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 and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20240301121209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: MEGAN CARE HOME
FACILITY NUMBER: 079200932
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2024
Section Cited
CCR
87468.1(a)(12)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(12)To wear their own clothes...

This requirement is not met as evidenced by:
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By POC Administrator agrees to train employees on laundry services and create a system to identify residents clothes and notify CCLD.
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Based on interview with staff residents clothes have gotten mixed up and its gone unoticed for about a week which poses a personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5