342700396-9-2-2020-27-AS-APEZ-BTBVFF-20200910162350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700396
Report Date: 09/02/2020
Date Signed: 09/02/2020 03:21:04 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
04/10/2020 and conducted by Evaluator Melissa Lusby

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200410102636

FACILITY NAME:	LOVE & CARE FOR ELDER II		FACILITY NUMBER:	342700396
ADMINISTRATOR:	SUIUGAN, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	7990 COOK RIOLO RD		TELEPHONE:	(916) 412-7301
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	6	CENSUS: 4	DATE:	09/02/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Elizabeth Suiugan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Medications are accesssible to residents
Resident was left in soiled diaper for an extended period of time
Facility staff did not meet resident's needs
Facility staff did not administer medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Lusby contacted the facility via telephone on 9/2/2020 to deliver complaint findings for a complaint the department received on 4/10/2020 for the above allegations. Findings are delivered via telephone due to COVID-19 and pre-cautionary measures. LPA discussed the purpose of the call and the elements of the allegation with Elizabeth Suiugan, Administrator/Licensee. The complaint findings are as follows.

During the course of the investigation, LPA Lusby interviewed Administrator/Licensee, two staff, and two current residents. LPA Lusby conducted a file review and reviewed all documents obtained pertaining to R1. The results of the investigation are as follows:

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020

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-20200410102636

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: LOVE & CARE FOR ELDER II	FACILITY NUMBER: 342700396
	VISIT DATE: 09/02/2020

NARRATIVE

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Interviews conducted with staff revealed that R1 was able to transfer out of bed without assistance from staff. While R1 preferred staff's assistance and companionship, R1 was to manage incontinence care without help. Medications are kept within a locked cabinet, in a locked closet. In April, the Administrator moved the location where medication is stored, leaving medication out for a brief period of time, but still under staff supervision. Residents interviewed denied seeing medication left unlocked and/or accessible. Additionally, residents interviewed acknowledge they receive prompt assistance from staff when needed.

Resident (R1) was unavailable for an interview due to not having a personal phone and is no longer a current resident of the facility.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

LPA conducted an exit interview with Administrator/Licensee Elizabeth Suiugan, via telephone and a copy of this report will be provided to the facility via email. Elizabeth agreed to review the complaint findings, and return a signed copy to CCL.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Melissa Lusby	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020

LIC9099 (FAS) - (06/04)

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