374604447-5-24-2023-08-AS-DPOL-CT9PHY-20230629112043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604447
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:36:39 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2023 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20230314134442

FACILITY NAME:	CASA DE ORO RESIDENTIAL CARE		FACILITY NUMBER:	374604447
ADMINISTRATOR:	BAILEY, CHARITY		FACILITY TYPE:	735
ADDRESS:	3602 S CORDOBA AVENUE		TELEPHONE:	(619) 303-3717
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	26	CENSUS: 25	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Charity Bailey, Administrator		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff over medicated resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Charity Bailey, Administrator to discuss the purpose of the visit.
LPA conducted the initial investigation visit on March 22, 2023, and was able to interview clients, facility staff, and outside sources. LPA also reviewed records and conducted a physical inspection of the facility. It was alleged that staff over medicated resident. Interviews revealed that Client 1 (C1) came to the facility on the same medications from their prior facility. Interviews revealed that C1 has a roommate that stays up talking to C1 all night and that is why C1 is so tired.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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 08-AS-20230314134442

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CASA DE ORO RESIDENTIAL CARE	FACILITY NUMBER: 374604447
	VISIT DATE: 05/24/2023

NARRATIVE

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Interviews revealed C1 has been up the last couple of nights all night long and have slept during the day due to this. C1 has complained about being tired and feeling over medicated so the staff have been observing C1. A record review revealed that client has been steady on the same medications since arrival to the facility. The staff and Doctor are working closely to remove certain medications that should be as needed. Interviews also revealed C1 went from taking a pill to getting a monthly shot and that could possibly be the problem but there is not a definite answer as of yet. The investigation did not produce supporting evidence or supporting witness statements to substantiate staff over medicated resident. Based on the evidence obtained from interviews, and record review, the complaint allegation is unsubstantiated.

An exit interview was conducted with Charity Bailey, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

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