197605091-8-17-2023-31-AS-NGID-CV5NNK-20230828103650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605091
Report Date: 08/17/2023
Date Signed: 08/17/2023 10:59:52 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230810151204

FACILITY NAME:	YONG CARE HOME		FACILITY NUMBER:	197605091
ADMINISTRATOR:	GARY JOHNSON		FACILITY TYPE:	740
ADDRESS:	1539 W. AVENUE L-12		TELEPHONE:	(661) 916-9351
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 1	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Gary Johnson, Administrator		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff did not keep medications in a safe and locked place

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Angela Panushkina, Michael Cava and Christopher Alemoh conducted an unannounced complaint visit to this facility to investigate the above allegation. LPAs met with the facility Administrator, Gary Johnson, and explained the reason for the visit.

To investigate the above allegation, from 10:40am to 11:00am, LPAs conducted interviews and reviewed documents pertaining to the allegation. Interviews with the Administrator and S1 confirmed that on August 7th, 2023, a random visit was made by a credible witness who observed Over-the-counter medication inside the fridge and bottles of medications/vitamins on the kitchen counter were not secured/locked and were accessible to residents in care. During today’s visit, LPAs also observed over-the-counter medications/vitamins left on the kitchen counter and accessible to residents in care. Review of facility’s Medication Policy states that all prescribed and over-the-counter medications will be kept in a safe and locked place that is not accessible to residents in care. Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 31-AS-20230810151204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: YONG CARE HOME	FACILITY NUMBER: 197605091
	VISIT DATE: 08/17/2023

NARRATIVE

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This is an immediate health and safety risk to clients in care. Based on the information gathered during the visit, the allegation is deemed SUBSTANTIATED

Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report.

Exit interview conducted. Appeal rights explained and a copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230810151204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: YONG CARE HOME	FACILITY NUMBER: 197605091
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/18/2023 Section Cited CCR 87465(h)(2)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to schedule vendorized medication training for all staff by 08/18/23 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion.
	8 9 10 11 12 13 14	Based on interview with a credible witness, the licensee did not comply with the section cited above to ensure that prescribed and PRN medication were kept locked and inaccessible to residents. This poses an immediate health and safety risk to residents 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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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