390314809-9-15-2020-27-AS-LKIG-BTJNWC-20200917104915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 390314809
Report Date: 09/15/2020
Date Signed: 09/15/2020 01:57:45 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
09/04/2020 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200904155502

FACILITY NAME:	O'CONNOR WOODS ASSISTED LIVING		FACILITY NUMBER:	390314809
ADMINISTRATOR:	LEAL-MALLETE, PENNY		FACILITY TYPE:	741
ADDRESS:	3334 WAGNER HEIGHTS RD		TELEPHONE:	(209) 956-3400
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	499	CENSUS: 332	DATE:	09/15/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Telephone Call Due To COVID-19 Precautionary Measures - Administrator Dawn Shimel		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff neglect led to hospitalization of resident
Resident's wound became infected while in care
Facility staff left resident in soiled clothing for an extended period
Facility staff did not dispense resident’s medication as prescribed
Facility staff did not notify the resident's authorized representative of a change in the resident's condition
Facility staff did not seek medical attention in a timely manner
Facility staff did not ensure that resident had an adequate amount of liquids

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace contacted Administrator Dawn Shimel on this day to conclude a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. A physical visit was not conducted in that the Department is not conducting Residential Care for the Elderly visits at this time, due to the COVID-19 virus.

LPA Wallace was informed by facility that R1 was not a resident in Assisted Living facility, R1 was in Meadowood a Skilled Nursing Facility during the time period in question.

Based on the fact that R1 was not a resident at facility, the allegations are deemed UNFOUNDED. This agency has investigated the allegation noted above and have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. We have therefore, dismissed the complaint.

Exit interview conducted with Administrator Dawn Shimel and a copy of this report was sent via email “read document”. Administrator will sign and send back to LPA via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

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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