347005713-12-13-2022-27-AS-SRIN-CM5UP2-20221215144450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005713
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:57:31 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, 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
08/10/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220810094936

FACILITY NAME:	DANIEL RESIDENTIAL CARE HOME LLC		FACILITY NUMBER:	347005713
ADMINISTRATOR:	DIALA, JOYCE		FACILITY TYPE:	740
ADDRESS:	4295 AMAPOLA WAY		TELEPHONE:	(916) 717-3263
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	6	CENSUS: 4	DATE:	12/13/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Care Staff Helen Agbiriogu		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not assist resident with medication refills in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met by Care Staff Helen Agbiriogu who called administrator Emmanuel Diala. LPA Lund spoke administrator Emmanuel Diala and explained the reason for the visit. Administrator Emmanuel Diala could not make the visit today and gave permission for care staff Helen Agbiriogu to sign required paperwork.

Staff did not assist resident with medication refills in a timely manner- Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that resident (R1) was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. R1 complained to staff and Administrators Emmanuel & Joyce Diala that R1 wanted to take unprescribed medications.

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Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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 27-AS-20220810094936

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: DANIEL RESIDENTIAL CARE HOME LLC	FACILITY NUMBER: 347005713
	VISIT DATE: 12/13/2022

NARRATIVE

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R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022^, R1 was admitted to the hospital and came back to the facility from August 20, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return back to the facility. Administrators and staff only gave R1 prescribed medications according to the Medication Administration Record (MAR) dated August 3 through August 31, 2022.

LPA Lund interviewed staff and resident in care. Staff stated, “That they only give medications according to the MAR and give the medication to residents in care in a timely manner. Residents stated, “That they get the medications when they ask for them and when staff give it to them.”

Based on facility records, interviews with staff and residents on the information provided, it was unclear if staff did not assist resident with medication refills in a timely manner therefore the allegation was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with care staff Helen Agbiriogu

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

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