342700067-10-18-2021-27-AS-KHOS-C7ZKY8-20211021081842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700067
Report Date: 10/18/2021
Date Signed: 10/18/2021 04:38:29 PM

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
10/07/2021 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20211007135506

FACILITY NAME:	HOSPITALITY HOUSE		FACILITY NUMBER:	342700067
ADMINISTRATOR:	SONYA SMITH		FACILITY TYPE:	740
ADDRESS:	5400 KIERNAN AVENUE		TELEPHONE:	(209) 543-9275
CITY:	SALIDA	STATE: CA	ZIP CODE:	95368
CAPACITY:	80	CENSUS: 52	DATE:	10/18/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Sabrina Duarte, Resident Care Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Administrator is telling other resident's his personal information
Resident is not receiving medication as prescribed
Facility is putting laxatives in resident's food and drink

INVESTIGATION FINDINGS:

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Licensing Program Analyst’s (LPA) Sarah Hurt arrived at the facility unannounced to deliver complaint findings on the above allegations. LPA met with Resident Care Director Sabrina Duarte and explained the purpose for the visit.

Regarding the allegation Administrator is telling other residents his personal information. Based on staff interviews all staff stated they have only witnessed Administrator Lorraine being professional in speaking in front of residents. The staff interviewed all stated they have never heard Administrator Lorraine speak about residents confidential information while other residents were present. 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.

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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: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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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Control Number 27-AS-20211007135506

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: 10/18/2021

NARRATIVE

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Continued from page 1...

Regarding the allegation that resident is not receiving medication as prescribed. Based on review of the Electronic Medication Administration Records resident is being given all prescribed medications daily. There is nothing documented that shows resident has missed or refused any medications. 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 allegations that facility is putting laxatives in resident's food and drink. Based on Electronic Medication Records Resident was prescribed laxatives, and fiber by a doctor as needed (PRN) several times. The Electronic Medication Records show Resident never requested the laxatives so facility staff never gave them to him. Therefore, this complaint is UNSUBSTANTIATED. A finding that the 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.

Per title 22 no deficiencies being cited during this visit. Exit interview conducted and a copy of this report was 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: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

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