157208828-2-21-2023-24-AS-SPIY-CPBLCJ-20230223073825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208828
Report Date: 02/15/2023
Date Signed: 02/21/2023 10:15:30 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, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220902134324

FACILITY NAME:	A GOLDEN HEART FAMILY CARE		FACILITY NUMBER:	157208828
ADMINISTRATOR:	LIGON, MICHELLE		FACILITY TYPE:	740
ADDRESS:	13402 GIRO DRIVE		TELEPHONE:	(661) 368-2333
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY:	6	CENSUS: 6	DATE:	02/15/2023
		UNANNOUNCED	TIME BEGAN:	12:23 PM
MET WITH:	Administrator, Jocelyn Ligon and Michelle Ligon		TIME COMPLETED:	12:56 PM

ALLEGATION(S):

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Neglect resulting to resdient not receiving treatment on time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted a follow up visit to deliver findings. LPA Williams met with Administrator, Jocelyn Ligon and Michelle Ligon.

LPA Shawnna Doucette and LPA Williams have conducted interviews and record reviews.

According to Kaiser Permanente documents, a fax was sent to the facility on 8/23/2022, notifying to pick up a new prescription medication and urine sample was to be collected for Resident 1.

However, the Administrator Michelle Ligon reported and provided documentation of the notification being received by fax with a stamped receival date of 8/29/2022.

*Continued on LIC 9099-C*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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 24-AS-20220902134324

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: A GOLDEN HEART FAMILY CARE	FACILITY NUMBER: 157208828
	VISIT DATE: 02/15/2023

NARRATIVE

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Administrator MIchelle Ligon reported once the fax was received, she attempted to pick up the medication, but it was not at the pharmacy which they call “Ming”. LPA Williams observed notes in Kaiser Permanente documents regarding Witness 1 requesting medication to be transferred to “Ming” Pharmacy from an unknown pharmacy.

The medication was started on 9/1/2022.

The Administrator reported a urine sample could not be collected for Resident 1 due to medical issues. The Administrator reported speaking to Witness 2 via phone requesting alternative means to collect a sample.

LPA Williams attempted to contact Witness 1 and Witness 2 to clarify statements and documents. LPA Williams left voicemail's requesting return calls and at the time of this report, none have been returned from Witness 1 or Witness 2.

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.

An exit interview was conducted, and a copy of this report will be provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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