342700567-1-23-2023-25-AS-LMUZ-CNH2R5-20230127163659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700567
Report Date: 01/23/2023
Date Signed: 01/23/2023 09:24:58 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/29/2022 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 25-AS-20221129143139

FACILITY NAME:	FRIENDLY CARE HOME		FACILITY NUMBER:	342700567
ADMINISTRATOR:	HITICAS, DANIEL		FACILITY TYPE:	740
ADDRESS:	8934 VAN MOORE LN		TELEPHONE:	(916) 792-9428
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	6	CENSUS: 6	DATE:	01/23/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Staff (caregiver) - Alena Tripadush		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Facility does not serve food of good quality to residents in care.
Staff do not ensure that special dietary needs of resident are being met.
Staff do not ensure that resident is receiving assistance with bathing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/23/2023 to deliver findings of the complaint investigation for above allegations. LPA met with staff ,caregiver- Alena Tripadush and explained the purpose of the visit. Prior to the visit , LPA completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA wore the following Personal Protective Equipment (PPE) during today's visit-surgical mask. LPA was screened by facility staff upon entry.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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 25-AS-20221129143139

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: FRIENDLY CARE HOME	FACILITY NUMBER: 342700567
	VISIT DATE: 01/23/2023

NARRATIVE

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***CONTINUED FROM LIC9099........***

Allegation- Facility does not serve food of good quality to residents in care.

Allegation- Staff do not ensure that special dietary needs of resident are being met.

Department reviewed facility records, conducted interviews with staff and residents and facility’s observation to investigate the complaint allegation. On 11/30/22 and 12/28/22, Department interviewed 5 out of 6 residents and 2 out of 3 staff members and found out that facility was serving good quality foods with different food choices to all residents and there were no issues. During department interview, R1 stated that they are aware that they are on ‘carb control’ diet due to their health issues but sometimes not to choose to order “carb control” food items. R1 stated that they are alert and able to make their own choices and enjoy the food which they want instead of what the doctor ordered. R1 acknowledged they are aware about ‘risk and benefits’ for not following the diet ordered by the doctor but it is their own choice. R1 stated that facility always offers quality food alternatives that meets their diet order but prefers ‘junk food’ brought from family and friends. Record review for R1 indicated that R1s LIC602 dated 03/21/22 stated that R1 is alert and able to express their needs and can made their own care choices. R1 also stated that they were happy living at the facility with no issues. Based on all this information, this allegation is UNFOUNDED.

**Report continued on LIC9099-C**

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20221129143139

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: FRIENDLY CARE HOME	FACILITY NUMBER: 342700567
	VISIT DATE: 01/23/2023

NARRATIVE

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***CONTINUED FROM LIC9099........***

Allegation- Staff do not ensure that resident is receiving assistance with bathing.

Department reviewed facility records, conducted interviews with staff and residents and facility’s observation to investigate the complaint allegation. On 11/30/22 and 12/28/22, Department interviewed 5 out of 6 residents and 2 out of 3 staff members and determined that staff assist residents, including R1 for their shower needs. All residents interviewed stated that their care needs are met including showers and did not express any concerns. During the department interview with R1, R1 stated that it was their own choice not to take showers and take full bed bath/sponge bath daily which they have been receiving from facility staff with no issues. R1 also stated that they are alert and able to make their own care needs choices. Record review for R1 indicated that R1s LIC602 dated 03/21/22 stated that R1 was alert and able to express their needs and can made care choices. R1 also stated that they were happy living at the facility with no issues. Based on all this information, this allegation is UNFOUNDED.

Based on records reviewed, the above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis.

No citations were issued today. A copy of this report has been provided to facility. Exit interview conducted.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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