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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700997
Report Date: 03/30/2022
Date Signed: 04/15/2022 11:09:27 AM

Substantiated


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
01/21/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220121155252
FACILITY NAME:CAMLU ASSISTED LIVINGFACILITY NUMBER:
392700997
ADMINISTRATOR:WHITTED, ALMAFACILITY TYPE:
740
ADDRESS:6037 N. PERSHING AVENUETELEPHONE:
(916) 759-1969
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:160CENSUS: 50DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alma WhittedTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Positive COVID-19/symptomatic staff are required to work at the facility
INVESTIGATION FINDINGS:
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On 3-30-22 at 10:00am Licensing Program Analysts (LPAs) Maja Jensen and Michael Bilger arrived at facility unannounced to continue a complaint investigation and deliver complaint findings for the allegations noted above. LPAs were allowed access to the facility and screened at the front door for COVID symptoms. LPAs Jensen and Bilger met with Administrator Alma Whitted and Resident Care Coordinator Andrea Eldridge and informed of the purpose of today's visit.

LPAs Maja Jensen and Michael Bilger reviewed COVID screening logs, payroll logs and staffing schedules. LPA Jensen also conducted interviews with staff 1 (S1) and staff 2 (S2) and resident 1 (R1). LPA Jensen observed that on 1/18/22, 1/19/22, 1/20/22 and 1/23/22 staff members documented that they were experiencing COVID symptoms. On 1/16/22 a staff member documented that they were experiencing COVID symptoms and tested positive. LPAs also verified that the staff that confirmed they have COVID sypmtoms worked on the dates they attested to having symptoms. In addition, during the course of an interview, S2 and advised there was pressure to come to work despite complaining of being symptomatic with COVID. During the course of an interview with R1, R1 advised they learned that staff was pressured to come in to work despite not being able.

Based on the COVID screening logs and interviews conducted the preponderance of evidence standard has been met, therefore this allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
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-20220121155252
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: CAMLU ASSISTED LIVING
FACILITY NUMBER: 392700997
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2022
Section Cited
CCR
3205(c)(2)(B)
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COVID-19 Prevention

The employer shall develop and implement a process for screening employees with COVID-19 symptoms.
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The licensee shall agree to not allow employees to work that are symptomatic or test positive and are symptomatic with COVID-19. This is an amendment of the LIC 9099-D of 3/30/22 and replaces the LIC 9099-D of 3/30/22.
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This requirement was not met as evidenced by based on COVID screening logs for teh dates of 1/18/22, 1/19/22, 1/20/22 and 1/23/22 the licensee did not ensure the rights of persons in care to safe and health accomodations in that staff members were allowed to work while experiencing COVID-19 symptoms, which poses a threat to the health and safety of clients.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: 916-639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC9099 (FAS) - (06/04)
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