015601365-1-27-2023-15-AS-KHOS-CP3NH9-20230215092819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601365
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:36:28 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
07/01/2022 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20220701122524

FACILITY NAME:	ALMOND ROAD SENIOR ESTATES		FACILITY NUMBER:	015601365
ADMINISTRATOR:	RUSU, OLIVIA		FACILITY TYPE:	740
ADDRESS:	17635 ALMOND ROAD		TELEPHONE:	(510) 886-0341
CITY:	CASTRO VALLEY	STATE: CA	ZIP CODE:	94546
CAPACITY:	6	CENSUS: 5	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Olivia Rusu, Admnistrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not responding to resident's call button
Unlawful eviction
Staff made inappropriate comments towards resident
Staff left resident in soiled diapers for extended period of time
Staff are not providing activities for residents
Staff are not providing adequate food service for residents
Staff are restricting visits
Staff did not provide resident with an update copy of admission agreement with new fees
Staff refused to use Hoyer lift for resident

INVESTIGATION FINDINGS:

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On 1/27/2023 at 11:45AM Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver complaint finding for the above allegations. LPA met with Administrator, Olivia Rusu and explained the purpose of the visit.
The allegation: Staff are not responding to resident's call button:
Investigation Finding: UNSUBSTANTIATED
LPA interviewed R1, and R2 states that they have no problem whenever they press the call button. LPA interview S1 and S2 states that they attended to the residents whenever they hear the call button goes off. The allegation: Unlawful eviction:
Investigation Finding: UNSUBSTANTIATED
LPA did record reviewed the letter that was sent date 6/19/22 is to notify that they are having concerned about the resident and needs the resident to be evaluated by the doctor. The facility tired to set up many appointments with the resident responsible party. There are logs that indicated that the facility reached out to R1 responsible party.
Report contine on LIC 9099c...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20220701122524

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: ALMOND ROAD SENIOR ESTATES	FACILITY NUMBER: 015601365
	VISIT DATE: 01/27/2023

NARRATIVE

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The allegation: Staff made inappropriate comments towards resident: Staff left resident in soiled diapers for extended period of time

Investigation Finding: UNSUBSTANTIATED

LPA interviewed R1, S1, and S2 stated one particular resident likes to yell and doesn’t like to have the diaper change. R1 states that “I can hear the person yelled at the staff. All the staff did was tried to calm the resident down. I heard that the resident yelled out leave me alone, and I don’t want to get my diaper change”.

The allegation: Staff are not providing activities for residents:

Investigation Finding: UNSUBSTANTIATED

LPA observed the following during the tour on 9/22/22 that residents was interacting in the living room area singing and listening to music. Some residents were coloring, and some were watching television. Staff are providing activities for residents at the facility.

The allegation: Staff are not providing adequate food service for residents:

Investigation Finding: UNSUBSTANTIATED

LPA observed on 9/22/22 residents are being provided with adequate food that are being served to the residents. LPA observed the facility provided a lunch menu for resident.

Report Continue on LIC 9099c...

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20220701122524

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: ALMOND ROAD SENIOR ESTATES	FACILITY NUMBER: 015601365
	VISIT DATE: 01/27/2023

NARRATIVE

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The allegation: Staff denied resident visitors:

Investigation Finding: UNSUBSTANTIATED

LPA did record reviewed of visitation logs showing that visitors are allowing visitation follow by the Public health visitation guideline and facility policy. Which indicate that all visitor needs to call and schedule in advance.

The allegation: Staff did not provide resident with an update copy of admissions agreement with new fees:

Investigation Finding: UNSUBSTANTIATED

LPA reviewed the conversation log via text messages between the administrator and resident responsible party. The text messaged indicated that the reporting party have confirmed that they received an update copy of admissions agreement with the new fees.

The allegation: Staff refused to use Hoyer lift for resident:

Investigation Finding: UNSUBSTANTIATED

LPA review R1 physician reports and any recommendation that were giving by the physician there were no physician orders for facility to use a Hoyer lift or recommendation of using the Hoyer lift.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview is conducted and a copy of this report is provided.

SUPERVISOR'S NAME: Bennett Fong	TELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Kelly Nguyen	TELEPHONE: (510) 915-8702
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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