415600808-2-24-2021-14-AS-KHOS-BYJQAW-20210224110038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600808
Report Date: 02/22/2021
Date Signed: 02/24/2021 10:32:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2020 and conducted by Evaluator Shabana Buksh

COMPLAINT CONTROL NUMBER: 14-AS-20200512153519

FACILITY NAME:	ALWAYS TLC		FACILITY NUMBER:	415600808
ADMINISTRATOR:	CONSUNJI, TOMAS		FACILITY TYPE:	740
ADDRESS:	226 SANDPIPER COURT		TELEPHONE:	(650) 345-1441
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	6	CENSUS: 5	DATE:	02/22/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Thomas Consunji		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Due to neglect, resident developed a wound in her groin
Resident has untreated skin rash

INVESTIGATION FINDINGS:

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On 02/22/2021, Licensing Program Analyst (LPA) Buksh, conducted a tele - complaint investigation with Administrator, Tomas Consunji to discuss the following findings of the above allegation. On 05/12/2020,the Department received a complaint alleging that Due to neglect, resident developed a wound in her groin and resident has untreated skin rash.The department’s investigation of this complaint includes review of resident’s medical records, facility and other miscellaneous records, statements and interviews with staff and other possible witnesses. Regarding the above allegations, LPA reviewed R1's physician's report dated 9/9/2019 that states R1's has history of skin rash and was prescribed medication for treatment. R1 was admitted to the facility with the skin condition and facility staff administered the medication as prescribed. (reviewed R1's Medication Administration Record). During R1's stay at the facility, her rashes under the breast healed but new rashes in her groin developed. LPA reviewed nurse communication report dated 1/17/2020, where it was noted that groin rash was observed by the visiting nurse(N1). Staff was instructed to apply Nystatin powder and Calmoseptin ointment to wound. LPA interviewed both former and current facility staff of R1. Both facility staff stated that R1's rashes on the groin would get healed and would develop again despite all the care. The current facility's administrator stated that they did not see any neglect from the previous facility staff. Based on the interviews and record reviews, facility seek medical care for R1 during her stay at the facility and no neglect was observed, therefore the allegations were UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Shabana Buksh	TELEPHONE: (650) 266-8810
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

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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