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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005176
Report Date: 06/26/2020
Date Signed: 06/26/2020 02:30:44 PM



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
03/02/2020 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 27-AS-20200302163103
FACILITY NAME:RN CARE HOUSEFACILITY NUMBER:
347005176
ADMINISTRATOR:ESTANTE, EDDWARDFACILITY TYPE:
740
ADDRESS:6600 COWBOY WAYTELEPHONE:
(925) 413-4690
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 0DATE:
06/26/2020
ANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Edward EstanteTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Resident medication was not given their prescribed medications.
INVESTIGATION FINDINGS:
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On 6/26/20, Licensing Program Analyst (LPA) Kevin Mknelly attempted to arrange a call with Edward Estante, Administrator of facility RN Care House – 347005176 at approximately 2:15 PM.
LPA was unable to meet at the facility due to current circumstances. Due to this facility being inactive at this time, LPA emailed this report to the licensee for review and signature.

LPA reviewed client/resident records and conducted extensive interviews.

Evidence presented in the course of this investigation found that the medication alleged to have been missed on 3/2/20, for R1, was in fact not missed. Resident and staff interviews found that while the refill of the medication was completed on the last day of the previous bottle, the medication was refilled and no dose of the medication was
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020
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 27-AS-20200302163103
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: RN CARE HOUSE
FACILITY NUMBER: 347005176
VISIT DATE: 06/26/2020
NARRATIVE
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missed.
The doses or medication alleged to have been missed on 2/27/20 and 2/29/20 for R1 were unable to be corroborated by supporting statements nor documentation. As the medication was a cream, a quantity count was unable to be done. R1 statements conflicted with staff denial of the allegation and there were no other witnesses to these alleged events.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint 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.
As a result of this investigation, no deficiencies were cited, per Title 22 Regulations, Division 6.

Unable to obtain signature. Signature present on hard copy in file. LPA sent a copy of report for Administrator, Edward Estante to sign. Administrator to send a signed copy back to CCL.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2