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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600267
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:41:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2020 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20200814091452
FACILITY NAME:WRIGHT PLACE, THEFACILITY NUMBER:
415600267
ADMINISTRATOR:WRIGHT, JO ANNFACILITY TYPE:
740
ADDRESS:2525 ANNAPOLIS ST.TELEPHONE:
(650) 329-0911
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:6CENSUS: 1DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jo Ann WrightTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff administered supplements to residents without prescription
Licensee is operating an alternate business in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation and met with Jo Ann Wright, Administrator.

On 08/14/2020, the Department received a complaint with the above allegations. LPA Marrufo conducted an initial complaint visit on 08/24/2020.

During interview on 08/24/2020, ADM stated to have administered 5HTP pills to resident R1. During review of records, LPA Marrufo did not find 5HTP as a prescribed medication for R1. Two witnesses stated that the medication was not prescribed to R1.

See LIC9099-C for more information. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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 5
Control Number 26-AS-20200814091452
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: WRIGHT PLACE, THE
FACILITY NUMBER: 415600267
VISIT DATE: 08/24/2023
NARRATIVE
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LPA Marrufo obtained a document from the East Palo Alto Sanitary District board meeting held on 10/15/2018. The document states the East Palo Alto Sanitary Board paid $560 to “Joann Wright Catering” for “Catering Services for 10/14/18 RBM and 10/10/18 SBM.” The address for “Joann Wright Catering” is stated in the document as 2525 Annapolis St. East Palo Alto, CA 94303.

During interview on 08/24/2023, ADM stated that “RBM” stands for “Regular Board Meeting” and “SBM” stands for Special Board Meeting.” ADM stated to have provided catering services for the East Palo Alto Sanitary District and to have prepared the home in the facility kitchen. ADM stated to have been paid for catering services for businesses throughout East Palo Alto.

Based on records review and interviews with residents and staff, there is preponderance of evidence to prove the alleged violations did occur. Therefore, the allegations are substantiated.

See 9099-D for deficiencies cited per the California Code of Regulations, Title 22.

This report was reviewed with ADM Wright and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2020 and conducted by Evaluator David Marrufo
COMPLAINT CONTROL NUMBER: 26-AS-20200814091452

FACILITY NAME:WRIGHT PLACE, THEFACILITY NUMBER:
415600267
ADMINISTRATOR:WRIGHT, JO ANNFACILITY TYPE:
740
ADDRESS:2525 ANNAPOLIS ST.TELEPHONE:
(650) 329-0911
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:6CENSUS: 1DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jo Ann WrightTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff slapped resident
Staff refused to assist resident with warm clothing upon request
Facility not following meal plan
INVESTIGATION FINDINGS:
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During interview on 08/20/2020, 1 out of 1 interviewed resident stated to have observed ADM slap a resident.

During interview on 08/24/2020, ADM denied having ever slapped any resident.

During interview on 08/24/2020, 4 out of 4 interviewed residents denied ever being slapped by a staff or ADM. During interview on 08/24/2023, R2 denied ever being slapped or observing any resident being slapped by ADM or any staff.

During interview on 08/20/2020, 1 out of 1 interviewed resident stated that ADM pulled a shirt off a resident and told the resident ADM did not give the resident permission to wear a shirt.

During interview on 08/24/2020, ADM stated to have never denied a resident’s request to put on warm clothing.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 26-AS-20200814091452
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: WRIGHT PLACE, THE
FACILITY NUMBER: 415600267
VISIT DATE: 08/24/2023
NARRATIVE
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R1’s Physician’s Report states R1 requires a special Consistent or Controlled Carbohydrate (CCHO) diet.

ADM provided LPA Marrufo with R2’s Physician’s Report, which only included the first 2 out of 6 pages and was missing the page that indicates if R2 requires a special diet.

R2’s Discharge Medication form from a skilled nursing facility on 09/08/2019 indicated R2 was ordered a CCHO diet.

LPA Marrufo obtained a copy of a letter from R1’s family stating what food they requested be served to R1.

During interview on 08/24/2023, ADM stated to have followed the food recommendations provided by the family in the letter. ADM also stated to have provided soft foods for R2.

Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22

This report was reviewed with ADM Wright and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20200814091452
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: WRIGHT PLACE, THE
FACILITY NUMBER: 415600267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2023
Section Cited
CCR
87205(a)
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87205 Accountability of Licensing Governing Body(a): The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation
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Licensee agrees to submit plan of correction by POC date to CCL stating how licensee plans on preventing her catering business and any other business or activity which is not related to the licensing of the facility to be conducted at the facility.
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in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by: Licensee/Administrator has operated a catering service business at the facility, which poses an immediate safety risk to residents in care.
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Type A
08/25/2023
Section Cited
CCR
87465(e)
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87465(e) Incidental Medical and Dental Care For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription
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Licensee agrees to submit a plan to CCL by POC date to review CCL regulation 87465(e) and ensure all staff, including licensee/administrator, understand they are not to administer medications to residents that are not prescribed by the resident’s physician.
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blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement was not met as evidenced by: ADM Wright provided R1 with a supplement not prescribed by R1's physician, which poses an immediate safety risk to residents in care.
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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.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5