079200997-6-23-2022-15-AS-HHUL-CFR289-20220625170956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200997
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:11:16 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
01/18/2022 and conducted by Evaluator Grace Luk

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220118102109

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:	06/23/2022
		UNANNOUNCED	TIME BEGAN:	02:12 PM
MET WITH:	Abigail Okpara, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility illegally evicted resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/23/2022 at 2:12PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver complaint findings for the allegation above. LPA met with Administrator, Abigail Okpara.

During the investigation, LPA interviewed 1 staff and 3 witnesses. LPA obtained and reviewed R1's physician's report, discharge documents, medication list, and correspondence to CCLD.

LPA reviewed R1's file and observed facility was missing documents including: admission's agreement, pre-placement appraisal, and emergency information. Interview with staff indicated that R1 was sent out on 1/17/2022 to the emergency due to pain. S1 stated that R1 was not evicted and can come back to the facility. (Continue on LIC9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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-20220118102109

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: 06/23/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interview with witnesses revealed that S1 consulted with R1's doctor and made an effort to help with R1's chronic back pain. W2 stated that S1 was following Kaiser's instructions to bring R1 to the emergency room and Kaiser will find alternative placement for R1. W2 stated that R1's doctor and Kaiser was aware that R1 will be relocated.

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: Grace Luk	TELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2