342700067-6-20-2022-27-AS-KHOS-CFUL4X-20220629082615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700067
Report Date: 06/20/2022
Date Signed: 06/20/2022 04:01:41 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/31/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20220531161754

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	LORRAINE PADILLA		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 36	DATE:	06/20/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Lorraine Padilla		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not notify family of change of condition.
Illegal Eviction
Facility staff did not provide adequate supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit on June 20, 2022 at 02:30 p.m. to complete and investigation on the above allegations. LPA met with Administrator Lorraine Padilla and explained the purpose of today's visit.

Regarding the allegation facility staff did not notify family of change of condition. Based on LPA interviews, records reviewed, and observation Resident 1's responsible party is hard to reach. LPA reviewed four facility incident reports documenting facility contacting responsible party. Administrator Lorraine Padilla stated facility staff would attempt to contact responsible party for Resident 1 even leaving voicemails, but he would rarely answer phone calls or return calls. Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued on 9099...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

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 27-AS-20220531161754

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HOSPITALITY HOUSE	FACILITY NUMBER: 342700067
	VISIT DATE: 06/20/2022

NARRATIVE

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Continued from 9099...

Regarding the allegation facility staff did not provide adequate supervision. Based on LPA interviews and records reviewed Resident 1 did have 3 separate falls on 02/15/2022 (unwitnessed), 05/27/2022 (unwitnessed), & 05/31/2022 (witnessed). It was realized after the 05/31/2022 witnessed fall Resident 1 needed more care and did not return to the facility. Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation Illegal Eviction. Based on interviews and records reviewed the facility did not illegally evict Resident 1. LPA reviewed facility care notes dated 05/19/2022, 05/29/22, and 05/31/22 documenting Resident Care Coordinator Sabrina Duarte notating Resident 1 needs a higher level of care. LPA spoke with Supervising Case Manager Deborah Vierra who stated she agreed Resident 1 needed more care than the facility could provide. Supervising Case Manager Deborah Vierra stated Resident 1 had very specific needs that required a facility with a nurse present. Supervising Case Manager Deborah Vierra stated she worked closely with the facility, and a placement agency to find a new facility that could provide the care needed for Resident 1. Therefore, this complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Administrator Lorraine Padilla and a copy of this report left at the facility.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

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