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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701180
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:19:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20231109083759
FACILITY NAME:COGIR OF TURLOCKFACILITY NUMBER:
502701180
ADMINISTRATOR:JOHNS, JANETFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: 68DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Tony Monellano, Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are mismanaging resident's medication
INVESTIGATION FINDINGS:
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On 03/14/24, Licensing Program Analyst Renee Campbell arrived unannounced to present findings for a complaint. LPA Campbell met with Tony Montellano, Executive Director and stated the purpose of the visit.

Regarding the allegation that staff are mismanaging residents medication, F1 reported that R1 had observed several instances of missing or incorrect medication. However no missing medication was found on the eMAR. S2 admitted that no errors were found on the eMAR because when R1 would identify a med error, the Med Tech corrected the error immediately.

Based on LPAs observation and interviews which were conducted and records reviewed, the preponderance of evidence standards has been met, therefore, the above allegation(s) is/are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit. Exit interview held, Appeal Rights discussed, Copy of report given.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/09/2023 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20231109083759

FACILITY NAME:COGIR OF TURLOCKFACILITY NUMBER:
502701180
ADMINISTRATOR:JOHNS, JANETFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not notify resident's authorized representative of change in level of care
Staff did not provide resident with a 60-day notice of rate increase
Staff did not keep residents personal information confidential
INVESTIGATION FINDINGS:
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On 03/14/24, Licensing Program Analyst Renee Campbell arrived unannounced to present findings for a complaint. LPA Campbell met with Janet Johns, Assistant Executive Director and stated the purpose of the visit.
Regarding the allegation that staff did not notify resident’s authorized representative of change of level of care, F1 reported that R1 was charged more when the number of med passes increased. Based on staff interviews and document reviews, LPA Campbell observed that there had been an increase in charges due to an accounting error but there had been no increase in med passes.
In regards to the allegation that staff did not provide resident with a 60 day notice of rate increase. F1 reported that she received a letter from the facility with no date on it. When questioned, F1 was able to refer to the letter’s envelope and identify that the post mark stated it had been mailed on 11/01/2024, Monday. The allegation is unsubstantiated as the rate increase was to occur on 01/01/2024 and this was 60 days after the letter was received
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20231109083759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COGIR OF TURLOCK
FACILITY NUMBER: 502701180
VISIT DATE: 03/20/2024
NARRATIVE
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In regards to the allegation that staff do not keep residents personal information confidential, the reporting party alleged that R2 had her blood pressure taken and was given her medication in the dining room in front of other residents. During two interviews, R2 stated that they took their own blood pressure and recorded the results for themselves and took her medicine with meals. Because R2 did not report a violation of their right to privacy, this allegation is UNSUBSTANTIATED.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.


SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20231109083759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COGIR OF TURLOCK
FACILITY NUMBER: 502701180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2024
Section Cited
CCR
87464(f)(4)
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87464 : Basic services shall at a minimum include:Personal assistance and care as needed by the resident and ... assistance with taking prescribed medications...
This requirement is not met as evidenced by
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All med techs will repeat their inservice training with an 8 hr training module and med techs will be required to pass a proficiency exam. The exams with their names and scores will be sent to the department as proof of completion as of the POC date.
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Based on interviews and documentation; the licensee did not ensure the resident received assistance and care with taking prescribed medications which poses a potential Health, Safety and Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Renee CampbellTELEPHONE: (916) 206-6380
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4