079201205-7-17-2024-15-AS-HHUL-D7GU5V-20240724151722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201205
Report Date: 07/17/2024
Date Signed: 07/17/2024 11:03:07 AM

Substantiated

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
06/10/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240610161837

FACILITY NAME:	LOVING HANDS		FACILITY NUMBER:	079201205
ADMINISTRATOR:	MORALES, MA MERCEDES R.		FACILITY TYPE:	740
ADDRESS:	2621 PRESIDIO DR		TELEPHONE:	(925) 330-5129
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	5	CENSUS: 4	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mercedes Morales, Adminstrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff do not keep the facility free from pests

INVESTIGATION FINDINGS:

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On XX/XX/2024 at 10:00AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Mercedes Morales.

On the allegation: Staff do not keep the facility free from pests. Based on observation and interviews LPA observed live small cockroaches in R1’s bedroom by the nightstand and by the behind a picture frame that was sitting on the ground next to the nightstand.

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 has been cited.

Exit interview conducted. A copy appeal rights, and this report provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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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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
06/10/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240610161837

FACILITY NAME:	LOVING HANDS		FACILITY NUMBER:	079201205
ADMINISTRATOR:	MORALES, MA MERCEDES R.		FACILITY TYPE:	740
ADDRESS:	2621 PRESIDIO DR		TELEPHONE:	(925) 330-5129
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	5	CENSUS: 4	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mercedes Morales, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff do not ensure a resident is being properly fed while in care
Staff do not ensure a resident consumes an appropriate amount of liquid
Staff mishandled a resident's personal belonging
Staff are interfering with a resident's visitations
Staff do not have planned activities for a resident
Resident sustained an unexplained injury while in care
Staff do not seek timely medical attention for a resident
Staff are mishandling a resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Mercedes Morales.

On the allegation facility staff do not ensure a resident is being properly fed while in care. Based on record review and interviews the resident is on hospice and has been since 04/15/24.

On the allegation facility Staff do not ensure a resident consumes an appropriate amount of liquid. Based on record review and interviews the resident was prescribed thick water by their primary care physician and the facility.

On the allegation facility Staff are interfering with a resident's visitations. Based on record review and interviews the facility were given instructions from R1’s Power of Attorney that W1 was not allowed to visit R1 at the facility.
Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 15-AS-20240610161837

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: LOVING HANDS	FACILITY NUMBER: 079201205
	VISIT DATE: 07/17/2024

NARRATIVE

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... Continued from LIC 9099-A

On the allegation facility Staff mishandled a resident's personal belonging. Based on interviews, S1 stated that R1’s glasses did accidentally break. S1 stated that she did send in a request to a replacement to R1’s optometrist and is waiting to hear back.

On the allegation facility Staff do not have planned activities for a resident. Based on record review and interviews the facility has a calendar of group events for the residents. S1 also explained that many of the residents participate in day programs either virtually or in person.

On the allegation facility Staff are mishandling a resident's medication. Based on record review R1 is on 12 medications. LPA reviewed R1’s Medication Administration Records and did not observe any issues.

On the allegation facility staff do not seek timely medical attention for a resident. Based on interviews with staff they stated that when residents need medical attention, they provide first aid and call 911.

On the allegation facility resident sustained an unexplained injury while in care. She did not have a wound on her elbow. S1 stated that she had a wound on her hand, due to a behavior of rubbing her hand on her face repetitively and a pressure injury on her left butt cheek. S1 explained that they had wound care nurses who were providing the care to the wound.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240610161837

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: LOVING HANDS	FACILITY NUMBER: 079201205
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors	1 2 3 4 5 6 7	The facility agrees to schedule regular pest control visits to come to the facility. Proof of correction will be sent to CCLD by POC date.
	8 9 10 11 12 13 14	Based on observation, the licensee did not comply with the section cited above by pests in the facility which poses/posed a potential health, safety or personal rights risk to 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: Jill Clancy-Czuleger	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

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