392700101-11-8-2022-27-AS-LKIG-CL8N2L-20221116090454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700101
Report Date: 11/08/2022
Date Signed: 11/08/2022 04:02:31 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
10/11/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20221011082218

FACILITY NAME:	MELISSA PATACSIL'S CARE HOME 2		FACILITY NUMBER:	392700101
ADMINISTRATOR:	PATACSIL, MELISSA		FACILITY TYPE:	735
ADDRESS:	8401 CAYUGA DRIVE		TELEPHONE:	(209) 477-4860
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95210
CAPACITY:	6	CENSUS: 4	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Melissa Kim		TIME COMPLETED:	04:02 PM

ALLEGATION(S):

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Staff are using illegal drugs at the facility.
Staff are not meeting resident's hygiene needs.
Staff does not check on residents during staff's shift.
Staff is serving expired food to residents.

INVESTIGATION FINDINGS:

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On 11-8-22 at 1:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegations noted above. LPA met with Administrator Melissa Kim and explained the purpose of the visit. During this investigation, LPA interviewed six staff members and three residents. LPA also reviewed facility file documentation including training records, care notes, personnel policies manual, and incident report. LPA also conducted facility observation on 10-17-22.

Allegation #1: Staff are using illegal drugs at the facility. LPA interviewed staff and residents as noted above. LPA also conducted facility observation and reviewed personnel policies manual. Based on interviews, and record reviews, there have been no confirmed reports or observations of staff using illegal drugs or intoxicated while on duty caring for residents. Facility observation conducted did not reveal any evidence of potential illegal drug use or intoxication in facility. Based on the interviews, record reviews, and observation conducted, there is not a preponderance of evidence to conclude illegal drugs are being used in the facility by staff. Therefore, this allegation is UNSUBSTANTIATED.
{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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-20221011082218

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: MELISSA PATACSIL'S CARE HOME 2	FACILITY NUMBER: 392700101
	VISIT DATE: 11/08/2022

NARRATIVE

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Allegation #2: Staff are not meeting resident’s hygiene needs. LPA interviewed residents and staff as noted above. LPA also reviewed care notes for resident1 (R1) and R2. LPA also observed residents in care during interviews conducted in addition to a general facility observation on 10-17-22. Interviews conducted revealed clients have been receiving assistance with hygiene and other needs. Based on LPA’s observation, residents in care appeared well groomed with no foul odors detected. A facility observation revealed grooming and other supplies necessary to meet resident’s needs were accessible for staff use. Care notes revealed staff intervention for hygiene and other needs. LPA also reviewed a medication treatment order for R1. Based on interviews, record reviews, and observations, there is not a preponderance of evidence to conclude staff are not meeting residents’ hygiene needs. Therefore, this allegation is UNSUBSTANTIATED.

Allegation #3: Staff does not check on residents during staff’s shift. LPA interviewed residents and staff as noted above. LPA also reviewed care notes for R1 and R2. LPA also conducted facility observation on 10-17-22. Based on records reviewed, it was revealed that staff conducts routine checks on residents in care across all shifts. Interviews conducted revealed staff are conducting routine checks on residents to ensure needs are met. LPA observed staff interacting regularly with residents and addressing needs. Based on interviews, record reviews, and observation, there is not a preponderance of evidence to conclude staff are not checking on residents during shifts. Therefore, this allegation is UNSUBSTANTIATED.

Allegation #4. Staff is serving expired food to residents. LPA conducted facility observation on 10-17-22 and interviewed staff and residents as noted above. During facility observation which included food supply in refrigerator, kitchen cabinets, and additional storage areas, LPA did not observe any expired food on hand and available for residents. Interviews conducted did not reveal expired food on hand and served to residents in care. It was further revealed during interviews that food reaching expirations dates are routinely discarded. Based on interviews and observation conducted, there is not a preponderance of evidence to conclude that facility has or is serving expired food to residents. Therefore, this allegation is UNSUBSTANTIATED.

No deficiencies cited. An exit interview was conducted with Melissa Kim and a copy of this report was left with Melissa. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: 916-862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

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