079200997-2-2-2023-15-AS-HHUL-CP5N8L-20230217091430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200997
Report Date: 02/02/2023
Date Signed: 02/02/2023 10:27:37 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
11/21/2022 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20221121113711

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: 1	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Fitzgerald Ohale, Caregiver		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Resident became severely dehydrated and developed a pressure injury while in care.

Facility not ensuring resident is fed.

Resident's grooming needs are not being met.

INVESTIGATION FINDINGS:

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On 2/2/2023 at 09:55AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Caregiver, Fitzgerald Ohale and explained the purpose of the visit. Administrator, Abigail Okpara arrived at 10:15AM.

During the course of the investigation, the Department conducted interviews with staff, Reporting Party (RP), obtained and reviewed records. On the above allegation, Resident became severely dehydrated while in care and developed a pressure wound, based on doctors’ notes dated 10/11/2022, there was insufficient evidence to show R1 being dehydrated or any signs of pressure wounds. Staff were also interviewed and denied R1 being dehydrated or complaining about pressure wounds. R1 no longer resides at facility and was not able to be interviewed. Based on the investigation the above allegations are unsubstantiated.

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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20221121113711

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: 02/02/2023

NARRATIVE

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Continued from LIC9099.

LPA interviewed staff, obtained and reviewed menus, and conducted a complete food inspection. R1 no longer there, however, R1 lived at the facility over 2 years. On the allegation facility not ensuring resident is fed, S1 stated during interview that on 11/10/2022, the day R1 was taken to the hospital, the ambulance came early in the morning and R1 had not eaten breakfast. S1 also stated R1 was able to eat finger foods but required some assistance with feeding. During record review LPA reviewed physician’s report that indicated R1 was able to feed himself.

On the allegation Resident’s grooming needs are not being met. S1 stated R1 had a licensed person coming in to cut his nails, but the person stopped coming and R1’s family started cutting his nails. During record review of progress notes dated 8/1/2022, it indicated that R1’s skin was cut after nail cutting conducted by R1’s family. S1 contacted Kaiser to send a licensed person but facility never received a referral.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore these allegations are 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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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