347001880-7-8-2022-25-AS-KHOS-CGBM9B-20220714092428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001880
Report Date: 07/08/2022
Date Signed: 07/08/2022 03:46:00 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, 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
05/17/2022 and conducted by Evaluator Jacob Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220517153120

FACILITY NAME:	ED DAVID CARE HOME #2		FACILITY NUMBER:	347001880
ADMINISTRATOR:	MARINA DAVID		FACILITY TYPE:	735
ADDRESS:	7200 LARCHMONT DRIVE		TELEPHONE:	(916) 331-4775
CITY:	NORTH HIGHLANDS	STATE: CA	ZIP CODE:	95660
CAPACITY:	6	CENSUS: 6	DATE:	07/08/2022
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Marta Blanco, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not provide assistance as necessary to meet the client's medical needs

INVESTIGATION FINDINGS:

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On 7/8/2022, Licensing Program Analyst (LPA) Jacob Williams arrived at the facility and met with Administrator, Marta Blanco, to conclude a complaint investigation into the allegation listed above. LPA wore a surgical mask and was screened by facility staff upon entry.

During the investigation, the Department conducted interviews, toured the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Staff did not provide assistance as necessary to meet the client's medical needs

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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-20220517153120

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: ED DAVID CARE HOME #2	FACILITY NUMBER: 347001880
	VISIT DATE: 07/08/2022

NARRATIVE

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R1 has been diagnosed with spinal chord compression which has caused him stroke-like symptoms including extreme weakness. R1 has been picked up from day program for experiencing such symptoms, and in an instance S1 has brought R1 with them to drop off groceries at the other Ed David Care Home facilities. There has not been any evidence of R1 being left in the car for any extended amount of time, and R1 was always capable of removing themself from the car if they so wished. During this sudden medical condition, it is apparent that staff have worked with R1's best interest in mind.

Based on interviews conducted by the Department and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is 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 and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC9099 (FAS) - (06/04)

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