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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001880
Report Date: 07/31/2024
Date Signed: 07/31/2024 09:20:25 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
03/11/2024 and conducted by Evaluator DeAnna Williams-Lyons
COMPLAINT CONTROL NUMBER: 59-AS-20240311102618
FACILITY NAME:ED DAVID CARE HOME #2FACILITY NUMBER:
347001880
ADMINISTRATOR:DIAMOND ANDERSONFACILITY TYPE:
735
ADDRESS:7200 LARCHMONT DRIVETELEPHONE:
(916) 331-4775
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 6DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Beasley, Mary Anne Caregiver TIME COMPLETED:
09:46 AM
ALLEGATION(S):
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Staff mishandled a client's medication

Staff did not properly report incidents involving a client
INVESTIGATION FINDINGS:
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On July 31, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings. LPA met with Mary Anne Beasley, Caregiver, and informed her the reason for the visit.

The Department investigated allegations that staff mishandled a client’s medication.

During the investigation, LPA interviewed 3 staff and 4 residents, reviewed file record and made observation. Interviews indicated on January 29, 2024 it was observed that R1’s medication had not been administered.

LPA interviewed 3 staff that had no information regarding the missed medication for R1.
LPA interviewed 4 residents and none of the resident had any information regarding missed medication.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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 2
Control Number 59-AS-20240311102618
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 #2
FACILITY NUMBER: 347001880
VISIT DATE: 07/31/2024
NARRATIVE
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Based on interviews, LPA’s observation and files reviewed, LPA did not find any evidence to prove or disprove the allegations were true or false. The allegations that staff mishandled a client's medication and staff did not properly report incidents involving a client to be UNSUBSTANTIATED, meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Per California Code of Regulations, Title 22, no citations were issued.

An exit Interview was conducted and a copy of this report was given to Mary Anne.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2