<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601180
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:00:40 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
12/10/2024 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241210100533
FACILITY NAME:PECH5 MG OC LLCFACILITY NUMBER:
415601180
ADMINISTRATOR:VERMA, NEERUFACILITY TYPE:
740
ADDRESS:800 ROBLE AVENUETELEPHONE:
(408) 807-1984
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:45CENSUS: 28DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Neeru VermaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have adequate medical equipment.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On December 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Neeru Verma and explained the purpose of the visit.

Regarding the allegation, facility does not have adequate medical equipment, according to the reporting party, Resident 1 (R1) is diabetic and the facility runs out of equipment, in specific test strips. According to the reporting party, the med-tech indicated that the test strips is on it's way, however reporting party indicated that they are unsure when the test strips will arrive.

During the visit, LPA interviewed Administrator, Med-techs, and observed R1's medications. According to the Administrator, R1's responsible party orders test-strips for R1 because R1's responsible party ordered a new machine for R1 and there are specific test strips that can be used. During the visit, LPA observed a full bottle of R1's test strips. According to the Administrator and Med-techs, prior to R1's new machine, the facility used to call the pharmacy for refills once a month for 30-day supply. In addtion, now with the new machine, med-techs will notify administrator when test-strips are low and administrator will contact R1's responsible party.

Based on interviews & observations, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report is reviewed with the administrator and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 1