345002875-7-27-2023-25-AS-KHOS-CVLGD8-20230912051445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002875
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:47:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
01/30/2023 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 25-AS-20230130085223

FACILITY NAME:	DAISY AWARD RESIDENTIAL CARE, THE		FACILITY NUMBER:	345002875
ADMINISTRATOR:	MELVIN, JOYCELYN E		FACILITY TYPE:	740
ADDRESS:	5121 ARROYO ST		TELEPHONE:	(415) 444-6875
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 4	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Joycelyn E Melvin, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries while in care due to neglect

Staff did not address resident's hygiene needs while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Joycelyn E Melvin, to deliver findings regarding the complaint allegations listed above.

During the course of the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Resident sustained multiple pressure injuries while in care due to neglect

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230130085223

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DAISY AWARD RESIDENTIAL CARE, THE	FACILITY NUMBER: 345002875
	VISIT DATE: 07/27/2023

NARRATIVE

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Administrator acknowledged that resident (R1) had wounds to their heel and buttocks area. Upon observing these wounds, Administrator was in direct contact with R1’s doctor and home health. Administrator reported that they provided care to R1 per the directions given to them by R1’s doctor and home health. As R1 did not respond to antibiotic treatment, Administrator appropriately advised R1’s doctor and sought direction. R1’s medical records revealed that the facility made contact with R1’s doctor to report R1’s condition on several occasions to request increased wound care. As such, R1’s home health visits increased. Additionally, home health records revealed that skilled nurses were providing care for R1 since 2/2/2022, prior to their placement at the facility. Of note, home health had actively provided treatment and care to R1’s wounds. In each session, home health did not report any concerns for R1’s condition, nor concern for their care by Administrator. For the duration of R1’s placement, Administrator and home health were actively responding to R1’s wounds, to include regular antibiotic treatment and regular bandage replacement. Based on the information and evidence obtained, the Department determined there is insufficient evidence to substantiate the allegation.

Allegation: Staff did not address resident's hygiene needs while in care

The Department conducted interviews during the investigation. Interview with Administrator indicated that residents are receiving weekly showers. Interview with caregiver indicated that staff are providing hygiene assistance. Interviews with residents R3, R4, and R5 indicated that they are receiving assistance with care. Interview with residents R1 and R6 did not indicate any concerns regarding care at the facility. During visits conducted on 1/30/2023 and 7/27/2023, LPA did not observe any residents in the care home unclean or not receiving care.

Based on interviews conducted, records reviewed, and observations, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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 with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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