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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201172
Report Date: 05/16/2023
Date Signed: 05/16/2023 01:49:58 PM

Unfounded


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
05/09/2023 and conducted by Evaluator Daisy Panlilio
COMPLAINT CONTROL NUMBER: 15-AS-20230509104128
FACILITY NAME:FRIENDSHIP CARE HOMEFACILITY NUMBER:
079201172
ADMINISTRATOR:SANDHU, SEEMAFACILITY TYPE:
740
ADDRESS:1907 CAVALLO ROADTELEPHONE:
(925) 732-7364
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:35CENSUS: 31DATE:
05/16/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cynthia Murphy, StaffTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mishandled the residents medication records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/16/23 at 12:45PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator and delivered investigation finding. LPA explained the purpose of the visit with administrator.

During investigation, LPA reviewed random 6 residents' (R1, R2, R3, R4, R5, R6) centrally stored medication logs with corresponding medication administration records for April & May 2023. LPA observed facility is meeting regulations for medication records perTitle 22 Sections 87465 and 87506. This department had investigated the complaint alleging that staff mishandled the residents medication records. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. No deficiencies cited. Exit Interview conducted and a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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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