247202428-3-4-2022-24-AS-SPIY-CCC2CQ-20220308161704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247202428
Report Date: 03/04/2022
Date Signed: 03/04/2022 12:19:32 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
11/17/2021 and conducted by Evaluator Lady Cabrera

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20211117131808

FACILITY NAME:	PARK MERCED		FACILITY NUMBER:	247202428
ADMINISTRATOR:	ELINA MOILANEN		FACILITY TYPE:	740
ADDRESS:	3050 M STREET		TELEPHONE:	(209) 722-3944
CITY:	MERCED	STATE: CA	ZIP CODE:	95348
CAPACITY:	125	CENSUS: 54	DATE:	03/04/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Elina Moilanen, Administrator		TIME COMPLETED:	11:13 AM

ALLEGATION(S):

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Staff are not properly screened for COVID-19.
Staff did not assist resident in receiving physical therapy as needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced subsequent complaint visit to the facility. LPA met with Administrator and stated the purpose of the visit.

During the course of this investigation, LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegations: Staff are not properly screened for COVID-19 and Staff did not assist resident in receiving physical therapy as needed is UNFOUNDED.

Per records reviewed and staff interviews, the staff are being screened for COVID-19. Staff will take their temperature, answer Covid-19 symptoms questions, staff will test weekly for covid-19, and will wear appropriate Proper Personal Equipment (PPE). On 11/24/2021 and 01/04/2022 facility visits, LPA observed staff with proper PPE.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 24-AS-20211117131808

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: PARK MERCED	FACILITY NUMBER: 247202428
	VISIT DATE: 03/04/2022

NARRATIVE

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LPA interviewed Resident’s Responsible Party and Care One Home Health, it was determined that Care One Home Health is responsible for setting up and maintaining the physical therapy appointments. Facility was not responsible to schedule physical therapy appointments for the resident and at times would get notify of the physical therapy appointment the day of by Care One Home Health.

This agency has investigated the complaint alleging (Staff are not properly screened for COVID-19.
Staff did not assist resident in receiving physical therapy as needed). We have found that the complaint was unfounded, therefore we have dismissed the complaint

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
11/17/2021 and conducted by Evaluator Lady Cabrera

COMPLAINT CONTROL NUMBER: 24-AS-20211117131808

FACILITY NAME:	PARK MERCED		FACILITY NUMBER:	247202428
ADMINISTRATOR:	ELINA MOILANEN		FACILITY TYPE:	740
ADDRESS:	3050 M STREET		TELEPHONE:	(209) 722-3944
CITY:	MERCED	STATE: CA	ZIP CODE:	95348
CAPACITY:	125	CENSUS: 54	DATE:	03/04/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Elina Moilanen, Administrator		TIME COMPLETED:	11:13 AM

ALLEGATION(S):

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Staff did not answer resident's call button in a timely manner.
Resident is not free from humiliation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced subsequent complaint visit on this date. LPA met with Administrator and stated the purpose of the visit. The Department has investigated the complaint alleging: Staff did not answer resident's call button in a timely manner and Resident is not free from humiliation.

During the investigation, LPA interviewed Resident (R1), R2, R3, R4, and R5, Staff (S1), S2, S3, and S4, and reviewed facilities call button records dated 10/08/2021-10/31/2021. Per staff interviews, if the resident aides are unable to respond to the call buttons then the medication technician or management will assist. Management are notified through the call button system if the staff are unable to respond in timely manner. On 01/04/2022, LPA pushed one of the resident’s call button. The staff responded within ten minutes. Per records reviewed, staff are required to explain on the call button logs the reason why they did not respond on time or if there were issues clearing the pendant.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20211117131808

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: PARK MERCED	FACILITY NUMBER: 247202428
	VISIT DATE: 03/04/2022

NARRATIVE

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In regard to second allegation, based on interviews conducted with staff, they respond to residents’ calls and have never made any derogatory comments towards residents’ toileting needs.

Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady Cabrera	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4