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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 04:26:19 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
12/21/2022 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 25-AS-20221221122146
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:
04:15 PM
MET WITH:Valerie Whitten, House LeadTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff are mismanaging resident's medications
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: Staff are mismanaging resident's medications

** 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 2
Control Number 25-AS-20221221122146
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. Due to facility receiving a citation regarding the same violation in a separate inspection conducted on 12/28/2022, no additional citations will be issued regarding allegation.

Exit interview was conducted with House Lead. A copy of this report was 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 2