435202896-7-31-2024-26-AS-KHOS-D8JPS3-20240827113340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202896
Report Date: 07/31/2024
Date Signed: 07/31/2024 03:42:36 PM

Unsubstantiated

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
10/23/2023 and conducted by Evaluator Simranjit Rai

COMPLAINT CONTROL NUMBER: 26-AS-20231023103508

FACILITY NAME:	NIJJAR HOME 2		FACILITY NUMBER:	435202896
ADMINISTRATOR:	NIJJAR, MANJINDER		FACILITY TYPE:	735
ADDRESS:	2742 CARASTON WAY		TELEPHONE:	(408) 341-5254
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	6	CENSUS: 6	DATE:	07/31/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Manjinder Nijjar		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility has staffing issues where client's needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Administrator, Manjinder Nijjar and stated the purpose of the visit.

On 10/23/2023, the Department received a complaint with the above allegation. It was alleged that the facility is short staffed where the residents have not been bathed or changed incontinence products.

Continuation on LIC 9099-C, Page 1 of 3.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

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 3

Control Number 26-AS-20231023103508

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: NIJJAR HOME 2	FACILITY NUMBER: 435202896
	VISIT DATE: 07/31/2024

NARRATIVE

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Page 2 of 3.

On 10/26/2023, the Department conducted an initial complaint investigation. The Department interviewed two staff, Administrator (ADM) and Staff S1. ADM stated 3 out of 6 residents need constant reminders, stand-by or 1:1 assistance with ADLs (Activities of Daily Living) and the other 3 residents are independent in their needs and require minimal supervision. ADM stated the facility has scheduled one staff in the morning shift and two staff for evening shift. ADM stated she will work at the facility and assist certain days of the week to provide extra support to the staff or cover shifts when staff are on vacation or called in sick. ADM stated they have not heard of complaints from the school staff or day program staff regarding the residents' toileting needs not being met. S1 stated the morning shift is able to care of the needs of the resident with 1 staff from 6am to 7am and the goal is for all residents to be assisted with toileting needs or incontinence care before they leave the facility to attend school or day program. S1 stated they are not able to control what happens beyond leaving the facility.

On 10/26/2023, LPA Rai was not able to interview residents since 6 out of 6 residents were attending day program during the visit.

Based on record review of 3 residents which require assistance with ADLs, 3 out of 3 residents require assistance or prompting with ADLs. 3 Out of 3 residents do not require 1:1 care and supervision. Based on record review, R3 may be noncompliant regarding showers and uncooperative during routine brief changes.

During today's visit, LPA Rai interviewed 6 residents. 5 Out of 6 (R1-R5) residents were not able to express more information beyond “hello”. R6 stated he/she did not want to be interviewed and was busy at the time of interview.

During today's visit, LPA Rai interviewed 2 staff (S2-S3). 2 Out of 2 staff stated the resident's needs are being met. S2 and S3 stated the residents are checked on every hour and staff will check to see if the resident needs assistance with toileting needs. S2 and S3 stated the staff are attentive to residents' physical cues since 3 residents are not able to express themselves and not able to verbally ask for help. S2 and S3 has seen the residents clean and being groomed in a timely manner. S3 stated resident R3 sometimes refuses to take a shower but staff will give cues and prompts to let R3 know in advance about scheduling the shower.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 26-AS-20231023103508

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: NIJJAR HOME 2	FACILITY NUMBER: 435202896
	VISIT DATE: 07/31/2024

NARRATIVE

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Page 3 of 3.

During today's visit, LPA Rai interviewed two San Andreas Regional Center agency personnel (Q1-Q2) who were present at the facility. Q1 and Q2 reviewed the weekly staff schedule for facility for this week (07/29/2024 - 08/04/2024) and they both agreed the facility staff is adequate to meet the resident's needs and Administrator and S1 are covering shifts wherein staff either call in sick or request the day off. Q1 and Q2 do not have concerns regarding staffing at the facility.

LPA Rai verified the weekly staff schedule Q1 and Q2 reviewed for this week is the same staffing coverage the facility provided for the month of October 2023. Based on facility schedule for October 2023, 2 staff are assigned to work the morning shift starting at 8 at the facility and 1 staff assigned to work from 6am - 7am. Based on LIC 500 updated on 10/30/2023, there is at least 1 staff member scheduled Sunday through Saturday 8pm - 8am and 2-3 staff members from 8am - 8pm Monday - Friday and 6am - 8pm Saturday - Sunday.

Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator Manjinder Nijjar and a copy of the report was provided.

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

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