342700936-9-13-2023-27-AS-KHOS-CWJHNZ-20231012062134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700936
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:46:39 PM

Unsubstantiated

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
07/18/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230718152835

FACILITY NAME:	OFODIRE CARE HOME II		FACILITY NUMBER:	342700936
ADMINISTRATOR:	OFODIRE, PEARL		FACILITY TYPE:	735
ADDRESS:	9400 FEICKERT DRIVE		TELEPHONE:	(916) 230-0690
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	4	CENSUS: 4	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Pearl Ofodire		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not provide activities to resident

INVESTIGATION FINDINGS:

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On 9-13-23 at 10:05am Licensing Program Analyst (LPA) Michael Bilger arrived at the facility unannounced to continue to conduct a complaint investigation regarding the above allegation. LPA met with the Administrator Pearl Ofodire and explained the purpose of the visit.

Throughout this investigation, LPA(s) Bilger and Villanueva conducted interviews with the Administrator and staff1 (S1). LPA also attempted interview with resident1 (R1) on 7-26-23. Additionally, LPA(s) conducted facility observations on 7-26-23 and 9-13-23, and reviewed facility file documentation including activity logs and on-going care notes.

{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 27-AS-20230718152835

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: OFODIRE CARE HOME II	FACILITY NUMBER: 342700936
	VISIT DATE: 09/13/2023

NARRATIVE

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Per review of R1’s Daily Activity Log for June through September 2023, facility offers and has available various activities daily for R1 and other residents based on preferences which include but are not limited to: iPad, puzzles, sporting activities, board games, computer games, arts and crafts, watering plants, walking or stretching exercises, meal preparations, shopping, piano, gardening, chores, sporting events, using massage chair, and doing chores. Additionally, outside activities offered include trips to Zoo, bowling, and library. Staffing initials in the log indicate whether R1 completed the activity or refused the offered activity. In June 2023, 18 activities were offered daily to R1, in which R1 refused a total of 55 times throughout the month. In July 2023, 17 activities were offered daily to R1, in which R1 refused a total of 39 times. In August of 2023, 22 activities were offered daily to R1 in which R1 refused a total of 41 times. In September of 2023, 22 activities have been offered to R1 as of 9-13-23, in which R1 has refused a total of 21 times. On-going care notes reviewed for the months of June 2023 through September 2023 indicate a consistency in R1's preferences which include IPAD use, music, neighborhood walks, arts and crafts, gardening and movies. Notes further indicate R1's usual preferences are IPAD use.

Furthermore, during a facility observation on 7-26-23 and 9-13-23, LPAs observed R1 using iPad and staff offering alternative activities such as drawing, board games, and exercise. In addition, on 7-26-23 and 9-13-23 LPAs observed evidence of activities including displays of arts and crafts on the wall in the activity area, as well as in residents’ bedrooms. In the activity area of the facility, LPAs also observed arts and crafts supplies including paints and brushes, as well as various activities for residents to use including puzzles, coloring books, and other tabletop activities. Photographs submitted by administrator were reviewed which indicated a birthday party for R1 at facility on 9-10-23.

Staff interviews, including the Administrator, revealed there are sufficient activities available for residents. The staff members advised that the facility has activities such as coloring, TV, music, outside walks, exercising, and other outside activities such as trips to library, zoo, and bowling. Interviews further revealed that R1 refuses often and prefers own leisure time and IPAD use. Interviews additionally revealed that additional residents living in the home participate in activities regularly.

{Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230718152835

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: OFODIRE CARE HOME II	FACILITY NUMBER: 342700936
	VISIT DATE: 09/13/2023

NARRATIVE

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Based on interviews, file reviews and observations, there is not a preponderance of evidence to conclude that the facility does not provide activities for residents. Therefore, this allegation is UNSUBSTANTIATED.
A finding of UNSUBSTANTIATED means that although the violations may have occurred as reported the preponderance of evidence standard was not met.

An exit interview was held, and a copy of this report was provided to Pearl Ofodire. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3