079200997-6-30-2023-15-AS-KHOS-CU3RG5-20230725130010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200997
Report Date: 06/30/2023
Date Signed: 06/30/2023 01:52:40 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
06/28/2023 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20230628102808

FACILITY NAME:	FAM CARE HOMES, LLC		FACILITY NUMBER:	079200997
ADMINISTRATOR:	OKPARA, CHIOMA ABIGAIL		FACILITY TYPE:	740
ADDRESS:	1502 PEPPERTREE PLACE		TELEPHONE:	(925) 481-4397
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY:	6	CENSUS: 2	DATE:	06/30/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Abigail "Chioma" Okpara, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff is restricting resident from having visitors

INVESTIGATION FINDINGS:

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On 6/30/2023 at 12:15pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct the 10-day initial visit and deliver complaint findings for the allegation above. LPA met with Abigail "Chioma" Okpara, Administrator and explained the reason for the visit.

During the course of the investigation LPA interviewed Staff, Reporting Party (RP), and a Resident 1 (R1). LPA requested the following documents be emailed to CCL by 7/3/2023: admission agreement, sign-in sheet, house rules, client roster, LIC500, physician's report, and email correspondence between family and facility. During interview the RP it was stated that the facility is restricting times for visits. R1 was admitted into the facility on 6/26/2023. R1 stated during interview that RP was told he

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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-20230628102808

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: FAM CARE HOMES, LLC	FACILITY NUMBER: 079200997
	VISIT DATE: 06/30/2023

NARRATIVE

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Continued from LIC9099.

only had 2 hours to visit because of the time he arrived at the facility. Both Staff stated during interview that the facility does not restrict visits and that visiting hours are from 10am to 6pm. LPA reviewed house rules which indicated the visiting hours are listed as staff stated. Review of sign-in sheet indicated R1's family have visited twice since admission.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore this allegation is UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC9099 (FAS) - (06/04)

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