415600267-8-24-2023-26-AS-KHOS-CVZPXH-20230925114224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600267
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:35:47 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
08/25/2020 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20200825133742

FACILITY NAME:	WRIGHT PLACE, THE		FACILITY NUMBER:	415600267
ADMINISTRATOR:	WRIGHT, JO ANN		FACILITY TYPE:	740
ADDRESS:	2525 ANNAPOLIS ST.		TELEPHONE:	(650) 329-0911
CITY:	EAST PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY:	6	CENSUS: 1	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Jo Ann Wright		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff is injecting resident with insulin

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Jo Ann Wright, Administrator (ADM).

On 08/25/2020, the Department received a complaint with the above allegations. On 08/26/2020, LPA Marrufo conducted an initial complaint investigation visit.

During interview on 08/26/2020, ADM stated to have injected resident R1 with prescription medication for diabetes. During interview on 08/24/2023, R1 stated that ADM has in the past injected R1 with diabetes medication into R1’s arm and without R1’s assistance. Based on records review and interviews with staff and residents, there is preponderance of evidence to prove the alleged violation did occur. Therefore, the allegation is 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.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
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 3

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
08/25/2020 and conducted by Evaluator David Marrufo

COMPLAINT CONTROL NUMBER: 26-AS-20200825133742

FACILITY NAME:	WRIGHT PLACE, THE		FACILITY NUMBER:	415600267
ADMINISTRATOR:	WRIGHT, JO ANN		FACILITY TYPE:	740
ADDRESS:	2525 ANNAPOLIS ST.		TELEPHONE:	(650) 329-0911
CITY:	EAST PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY:	6	CENSUS: 1	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Jo Ann Wright		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff is increasing resident's insulin dosage without doctor's orders

INVESTIGATION FINDINGS:

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During interview on 08/26/2020, ADM stated that R1’s physician ordered an increase in diabetic medication from 0.6 mg to 1.2 mg. LPA Marrufo obtained a copy of R1’s physicians order for the diabetic medication Liraglutide with the dosage amount of 0.6 mg from 09/14/2019.

LPA Marrufo was unable to obtain documentation that indicated R1’s diabetic medication had been ordered by R1’s physician to be increased in dosage.

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

No Deficiencies were cited under California Code of Regulations Title 22

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
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: 2 of 3

Control Number 26-AS-20200825133742

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 87629(a)	1 2 3 4 5 6 7	87629 Injections (a): The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the	1 2 3 4 5 6 7	Licensee agrees to submit a plan to train all staff to not inject resident with any medication and to understand that only residents or appropriately skilled professionals may administer injections.
	8 9 10 11 12 13 14	resident or by an appropriately skilled professional. This requirement was not met as evidenced by: Administrator stated to have administered R1 with injection medication, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David Marrufo	TELEPHONE: (650) 380-0519
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: 3 of 3