347001879-7-5-2023-59-AS-LMUZ-CTPURQ-20230713154908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001879
Report Date: 07/05/2023
Date Signed: 07/05/2023 11:05:05 AM

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
06/06/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20230606100839

FACILITY NAME:	ED DAVID CARE HOME #1		FACILITY NUMBER:	347001879
ADMINISTRATOR:	MARINA DAVID		FACILITY TYPE:	735
ADDRESS:	7125 CANAVERAL WAY		TELEPHONE:	(916) 332-2218
CITY:	NORTH HIGHLANDS	STATE: CA	ZIP CODE:	95660
CAPACITY:	6	CENSUS: 6	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Nene Collins		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff is denying residents their medications.
Facility staff falsified resident's documentation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 07/05/23 to deliver complaint findings for above allegations. LPA met with administrator, Nene Collins and explained the purpose of the visit. LPA wore the following Personal Protective Equipment (PPE) during today's visit-surgical mask.

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

**Report continued on LIC9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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 59-AS-20230606100839

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: ED DAVID CARE HOME #1	FACILITY NUMBER: 347001879
	VISIT DATE: 07/05/2023

NARRATIVE

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***report continued from LIC9099...........

Allegation- Facility staff is denying residents their medications.

Based on the department's investigation, including facility observations, record review, and interviews with staff and residents, it has been concluded that the allegation made against the facility regarding medication administration is unsubstantiated. The interviews with both staff and residents indicated that medications were being given to all residents on time, and the facility maintained proper logs and documentation for all medications according to physician's orders. The residents confirmed that they were receiving their scheduled medications in a timely manner, and the staff were not denying them their medications. Therefore , the allegation is determined to be without basis or evidence and is therefore considered unsubstantiated.

Allegation- Facility staff falsified resident's documentation.

Based on the information provided, the investigation conducted by the Licensing Program Analyst (LPA) did not find any evidence to substantiate the allegation of facility staff falsifying resident documentation. All six staff members who were interviewed denied being instructed to change or alter resident documentation, and none of them reported hearing about such instructions being given to other staff members. Additionally, a review of the records indicated that the facility was maintaining proper documentation of residents without any indications of alteration or falsification. Based on these findings, the LPA concluded that there is not enough evidence to support the allegation, and the findings are considered unsubstantiated.

A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

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

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC9099 (FAS) - (06/04)

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