435202599-11-9-2020-26-AS-RMAO-BVC4NK-20201113181513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202599
Report Date: 11/09/2020
Date Signed: 11/09/2020 11:07:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/20/2020 and conducted by Evaluator Joanne Roadilla

COMPLAINT CONTROL NUMBER: 26-AS-20200720101223

FACILITY NAME:	DIYA SENIOR CARE HOME		FACILITY NUMBER:	435202599
ADMINISTRATOR:	KAUR, BHUPINDER		FACILITY TYPE:	740
ADDRESS:	276 CLEARPARK CIRCLE		TELEPHONE:	(408) 629-0388
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	6	CENSUS: 6	DATE:	11/09/2020
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Bani Kaur		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Facility staff physically hit resident.
Facility staff is verbally abusive to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Complaint tele-visit today to deliver the investigation findings on the above allegations. The Department has suspended on site visits due to COVID-19 shelter in place order by Governor Newsom. LPA spoke to Administrator (ADM) Bani Kaur.

On 07/24/20, LPA conducted an initial 10-day investigation of the allegations that around 07/15/20, the facility staff physically hit resident and is verbally abusive to resident. LPA interviewed ADM, staff (S1) and 2 residents (R1-R2). LPA also requested for residents’ records.

Between 10/06/20 and 10/27/20, LPA interviewed residents (R2-R6) and 2 staff (S1 and S2).

Continued on 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

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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Control Number 26-AS-20200720101223

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: DIYA SENIOR CARE HOME	FACILITY NUMBER: 435202599
	VISIT DATE: 11/09/2020

NARRATIVE

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From resident interviews, 6 out of 6 residents stated that they have not seen any of the staff physically hit and verbally abuse any of the residents at the home around 07/15/20. 3 out 6 residents stated they have heard a staff yell at some of the residents before but not to be verbally abusive but instead this staff was just being firm with residents to follow the house rules.

From staff interviews, 3 out of 3 staff denied physically hitting residents or being verbally abusive to residents at the home around 07/15/20. Based on records review, staff who provide direct care to residents are trained on resident’s personal rights including elder and dependent adult abuse. Staff also received training on personal care services and needs of the elderly.

The department has completed the investigation of the above allegations. Based on interviews and records review, the department has found that the complaint was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited during today's tele-visit. Report was discussed with and a copy sent to Bani Kaur to sign and mail back to CCL.

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Joanne Roadilla	TELEPHONE: (408) 205-2348
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020

LIC9099 (FAS) - (06/04)

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