455002679-12-16-2021-25-AS-KHOS-C9YJLS-20211223060909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002679
Report Date: 12/16/2021
Date Signed: 12/16/2021 01:05:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2021 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20211008112012

FACILITY NAME:	HALLMARK HOUSE		FACILITY NUMBER:	455002679
ADMINISTRATOR:	MYERS, BRENDA		FACILITY TYPE:	740
ADDRESS:	935 HALLMARK DR		TELEPHONE:	(530) 605-4041
CITY:	REDDING	STATE: CA	ZIP CODE:	96001
CAPACITY:	6	CENSUS: 5	DATE:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Maria Teibel, Direct Care Staff		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident is being over medicated
Resident falls Due to overmedicated
Resident appears to have long/dirty fingernails

INVESTIGATION FINDINGS:

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On 12/15//2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit to deliver findings regarding the above allegations directed by the department. LPA met with Maria Teibel, Direct Care Staff and explained the reason for the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical masks. Additionally, LPA was screened by staff at the front door.

continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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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Control Number 25-AS-20211008112012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: HALLMARK HOUSE	FACILITY NUMBER: 455002679
	VISIT DATE: 12/16/2021

NARRATIVE

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Resident is being over medicated
Resident falls Due to over-medicated
Resident appears to have long/dirty fingernails

During interviews with Administrator, staff, residents, and records reviewed, it was determined; Resident is being over medicated, Resident falls Due to over-medicated, and Resident appears to have long/dirty fingernails to be unsubstantiated. LPA toured the facility, and during the visit, LPA interviewed Five of Five (5 of 5) residents, which all reported they have no concerns regarding medications or personal care. LPA interviewed Five of Five (5 of 5) staff, who reported they have never witnessed or heard anything regarding any Resident is being over medicated, Resident falls Due to over-medicated, or any residents having long/dirty fingernails. While reviewing records, LPA observed some medication errors (missed medications), but not any residents being over medicated. LPA will conduct a case management regarding medication errors. LPA finds the allegations to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

There were no citations issued during today's visit, copy of report was given. An exit interview was conducted

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty Valencia	TELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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