347003611-9-1-2022-27-AS-KHOS-CHZN3W-20220906100701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003611
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:12:48 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2022 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220721132854

FACILITY NAME:	PRECIOUS ANGELS CARE		FACILITY NUMBER:	347003611
ADMINISTRATOR:	ALEJO, GLORIA		FACILITY TYPE:	740
ADDRESS:	8983 RICHBOROUGH WAY		TELEPHONE:	(916) 549-2724
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 6	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Facility Staff		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not documenting medication administration appropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct a complaint investigation. LPA met with facility staff, and explained the purpose of the visit. The department has concluded the following as it relates to the following allegation: Staff are not documenting medication administration appropriately. Administrator/Licensee gave facility staff permission to sign on their behalf.

LPA Valerio reviewed the facility's form of medication tracking. LPA learned the facility utilizes the Centrally Stored Log, Destruction Logs, and physician's orders. Licensee stated staff know if a resident took or refused their medications for the shift based on daily notes. The facility does not use Medication Administrator Records (MAR), which is not a requirement of Title 22 regulations. LPA Valerio checked the centrally stored log for residents and observed the orders on the LIC 622 to match the prescription bottle and doctors orders.

Based on the above information, the allegation is UNFOUNDED. Per California Code of Regulations, no deficiencies were observed. Exit interview held, and a copy of the report was provided to facility staff.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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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