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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700073
Report Date: 12/28/2022
Date Signed: 12/28/2022 04:13:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/21/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20221121153822
FACILITY NAME:PEOPLE'S CARE WINFINFACILITY NUMBER:
342700073
ADMINISTRATOR:EKUNDARE, ADEBIMPEFACILITY TYPE:
735
ADDRESS:3418 WINFIN WAYTELEPHONE:
(916) 480-9660
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:4CENSUS: 3DATE:
12/28/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Valerie Whitten, House LeadTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Residents' medications are missing and not being stored
INVESTIGATION FINDINGS:
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On 12/28/2022, Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with House Lead, Valerie Whitten, to deliver findings into the complaint allegation listed above. LPA wore a surgical mask while inside the facility.

During the investigation, LPA conducted a medication count and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Allegation: Residents' medications are missing and not being stored

** Report continued to 9099-C **
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
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 3
Control Number 25-AS-20221121153822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: PEOPLE'S CARE WINFIN
FACILITY NUMBER: 342700073
VISIT DATE: 12/28/2022
NARRATIVE
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On 11/30/2022, LPA Michael Hood arrived at the facility and conducted a medication count. LPA observed a loose pill belonging to resident (R1) fall from an open bubble pack that was already administered. The pill was observed to be an 8:00 AM 10mg Loratadine.

A Facility Action Report (FAR) was generated by Alta California Regional Center (ACRC) on 12/20/2022 to address violations per Title 17 regulations. Information on the FAR is as follows:

On 12/12/2022, ACRC Liaison Support Coordinator (LSC) conducted an unannounced visit at People’s Care Winfin. Upon review of resident (R2’s) medications and Medication Administration Record (MAR) dated 11/18/2022 to 12/15/2022, ACRC observed missing staff initials/signatures for two different medications.

Based on records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

Exit interview was conducted with House Lead. A copy of this report and appeal rights were provided. The House Lead’s signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20221121153822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: PEOPLE'S CARE WINFIN
FACILITY NUMBER: 342700073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/29/2022
Section Cited
CCR
80075(b)
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80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:
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Facility will conduct an in-service with all staff on medication administration. Facility will submit to LPA information regarding in-service training, including time and date of in-service and training material, by POC due date of 12/29/2022.
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Based on medication count and records reviewed, the facility did not ensure R1 was receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3