079200997-9-29-2021-15-AS-KHOS-C7XMPJ-20211019094712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200997
Report Date: 09/29/2021
Date Signed: 09/29/2021 11:41:40 AM

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
05/19/2021 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20210519112038

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: 4	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Chioma Abagail Okpara, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Residents are not offered activities.

INVESTIGATION FINDINGS:

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On 09/29/2021 at 10:30AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to deliver complaint findings for the above allegation. LPA met with Chioma Okpara, Administrator, and explained the reason for the visit.

During the course of the investigation, LPAs conducted interviews with staff, residents, Reporting Party (RP), obtained and reviewed documents. Interviews and document review indicated that there were not activities being offered to residents. Staff was not able to provide an activity schedule. LPAs observed four (4) four of five (5) residents watching television.

Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.
Exit interview conducted. A copy of appeal rights and this report provided.

Substantiated

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: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 4

Control Number 15-AS-20210519112038

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/06/2021 Section Cited CCR 87219(i)	1 2 3 4 5 6 7	87219 (i) Facilities shall provide... equipment and supplies... including... newspapers, magazines... Special equipment and supplies... This requirement was not met as evidence by:	1 2 3 4 5 6 7	Administrator agreed to supply residents with games, newspapers and other activities. During visit LPA observed games and books. Deficiency cleared during visit.
	8 9 10 11 12 13 14	Based on LPA's observation and interviews, Licensee did not comply with the section cited above, which poses a potential health and safety risk for persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/19/2021 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20210519112038

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: 4	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Chioma Abagail Okpara, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff do not follow residents' modified diets.

Food services are inadequate.

Facility staff denied resident visitations.

Staff speak inappropriately to residents in care.

INVESTIGATION FINDINGS:

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On 09/29/2021 at 10:30AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to deliver complaint findings for the above allegation. LPA met with Chioma Okpara, Administrator, and explained the reason for the visit.

During the course of the investigation, LPAs conducted interviews with staff, residents, Reporting Party (RP), obtained and reviewed documents. LPAs reviewed physician’s report for Resident 1 (R1) and facility’s menu. The menu listed foods that coincided with R1’s diet.

On the allegation food services are inadequate. LPAs reviewed facility’s menu and observed a variety of food listed to be served. LPAs also observed a minimum of 7-day non-perishables and 2-day perishables foods.
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: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 15-AS-20210519112038

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: 09/29/2021

NARRATIVE

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On the allegation facility denied resident visitation. LPAs interview with RP stated that RP went to pick up R1 twice. LPAs reviewed visitation policy and sign-in sheet (3/27/21-5/30/21). Sign-in sheet indicated R1 had a visitors several times, therefore R1 was not denied visitation.

On the allegation staff speak inappropriately to residents in care. LPAs interviewed three (3) out of five (5) residents. Residents stated staff is polite and helpful. None of the staff have spoken inappropriately to residents and residents have not seen that occur to any of the other residents.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conduct and 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: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4