347001880-1-25-2024-59-AS-LMUZ-D233HF-20240201171550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001880
Report Date: 01/25/2024
Date Signed: 01/25/2024 02:02:50 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
12/28/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20231228114056

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:	01/25/2024
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Assistant Administrator, Valerie Whitten		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee does not ensure staff administering medication to residents are appropriately trained.
Staff are mismanaging resident's medications.
Staff falsify facility documents.

INVESTIGATION FINDINGS:

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On 01/25/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Assistant Administrator, Valerie Whitten.

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

The results of the investigation are as follows:

**Report continued on 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

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-20231228114056

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: 01/25/2024

NARRATIVE

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***Report continued from 9099-A.....

Allegation- Licensee does not ensure staff administering medication to residents are appropriately trained.

Based on interviews with staff, staff indicated that training was conducted at the time of hire and on a continuous basis per Title 22 regulations. The Department reviewed staff training records and observed that required training requirements were met. Staff interviewed indicated that staff have required mandated training upon hire and on a continuous basis per facility needs and requirement. Records reviewed indicated that the facility kept a proper record of all staff training, including medication training for all staff without any issues. Though training requirements are met, meaning classes were taken; the department cannot determine if all staff understood the training and applied it appropriately. Based on this information, this allegation is UNSUBSTANIATED.

Allegation- Staff are mismanaging resident's medications. Staff falsify facility documents.

The Department conducted facility observations, record review and interviews with staff and residents to investigate this complaint allegation. During interviews, it has been revealed that the facility dispensed all resident’s medications as prescribed. Records reviewed for November and December 2023, it has been discovered that the facility kept a proper log for all medications for residents in care in the centrally stored medication log per physician’s orders and documented in MAR without any errors. Record review for medication administration did not indicate any falsification of medication records for residents. Based on this information, this allegation is 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.
A copy of this report has been provided to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC9099 (FAS) - (06/04)

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