342701162-12-28-2023-27-AS-KHOS-CZ6JM9-20240104060959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701162
Report Date: 12/28/2023
Date Signed: 12/28/2023 03:09:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20231213100004

FACILITY NAME:	BRIGHT HOMES		FACILITY NUMBER:	342701162
ADMINISTRATOR:	SINGH, NIMEESHA		FACILITY TYPE:	740
ADDRESS:	7976 QUAKER RIDGE WAY		TELEPHONE:	(916) 661-9618
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	6	CENSUS: 5	DATE:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Puaula Puni		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff mishandled a resident's medications while in care

INVESTIGATION FINDINGS:

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On 12/28/23, Licensing Program Analyst (LPA) Tung Truong arrived at the facility unannounced to conclude the investigation of the above allegation and to deliver the findings. LPA met with facility staff Puaula Puni and explained the purpose of today's visit.

Throughout the course of the investigation, LPA Truong conducted interviews and reviewed facility records. Based on interviews and records review, it was learned that resident (R1) came to the facility with 30 tabs Risperidone and 21 capsules Depakote. Placement agent was only given back 19 tabs Risperidone and 4 capsules of Depakote. LPA reviewed R1’s Centrally Stored Medication and Destruction Record and observed Depakote (14 tabs) and Risperidone (9) were disposed on 12/13/23.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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 27-AS-20231213100004

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BRIGHT HOMES	FACILITY NUMBER: 342701162
	VISIT DATE: 12/28/2023

NARRATIVE

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Administrator Nimeesha Singh stated that R1 had taken 2 Risperidone and 3 Depakote prior to moving out. Administrator stated R1’s medications that was pre-packed were properly discarded and that there was no medication error occurred. In addition, LPA reviewed two residents’ medications and Medication Administration Records (MAR) and observed medication administration was documented according to Title 22 regulations.

As a result of the investigation, LPA finds the allegation above to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and a copy of the report was provided upon exit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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