157208939-5-21-2021-24-AS-SPIY-C4NTSD-20210706145857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208939
Report Date: 05/21/2021
Date Signed: 05/21/2021 12:52:23 PM

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
04/09/2021 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20210409131435

FACILITY NAME:	A GOLDEN HEART FAMILY CARE I		FACILITY NUMBER:	157208939
ADMINISTRATOR:	LIGON, JOCELYN		FACILITY TYPE:	740
ADDRESS:	13400 INDURAN DR		TELEPHONE:	(661) 679-6410
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY:	6	CENSUS: 6	DATE:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	07:46 AM
MET WITH:	Licensee Michelle Ligon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff who are not appropriately skilled professionals are administering resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced visit to commence a complaint investigation to deliver findings. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Licensee Michelle Ligon.

After reviewing and obtaining copies of Hospice records, facility records, interviewing Hospice staff and facility staff, it was found that Hospice staff was administering resident's medications that were required to be administered by a skilled professional.

This agency has investigated the complaint alleging Facility staff who are not appropriately skilled professionals are administering resident's medication. We have found that the complaint was UNFOUNDED, therefore we have dismissed the complaint.

An exit interview was conducted with Licensee Michelle Ligon and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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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