075600915-10-3-2022-15-AS-HHUL-CKMLG4-20221028084404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600915
Report Date: 10/03/2022
Date Signed: 10/03/2022 03:17:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/02/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220202131752

FACILITY NAME:	VALLEY VIEW CARE HOME III		FACILITY NUMBER:	075600915
ADMINISTRATOR:	ALIPING, JOEL & EMILY		FACILITY TYPE:	740
ADDRESS:	5117 RAINCLOUD DR.		TELEPHONE:	(510) 222-5631
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	6	CENSUS: 3	DATE:	10/03/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Joel Aliping, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident(s) sustained multiple injuries while in care at facility
Staff did not meet incontinence needs of residents/clients resulting to septic shock
Staff yelled in front of resident(s) or client/s

INVESTIGATION FINDINGS:

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On 10/03/2022 at around 10:45AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with Administrator Joel Aliping and explained to the reason for the visit.

During the course of the investigation, the Department conducted interviews with staff, residents/clients, health providers, and complainant. Clients medical records and facility file, incident report, and facility’s correspondence with health providers were obtained and reviewed.

…Continued to LIC9099C…

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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 15-AS-20220202131752

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: VALLEY VIEW CARE HOME III	FACILITY NUMBER: 075600915
	VISIT DATE: 10/03/2022

NARRATIVE

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Allegation: Resident(s) sustained injuries while in care at facility.

During the course of investigation, records review indicated that C3 was brought to emergency room on 1/6/2022 due to chief complaint of “resident getting weaker”. Upon admission at the emergency department, records review indicated that C3 was referred to a doctor for wound evaluation for “potential or confirmed pressure injury sacrum/buttock” , records indicated that wound is closed, none serous filled blister, no odor, no edema noted, records also indicated that wound is “not pressure injury”, another hospital records indicated that C3’s right and left heel had wound, however hospital records did not indicate the stage of wound, records reveal no sign of infection, skin was dry and intact. C3 was not admitted to the hospital due to other reason. LPA was unable to prove or disapprove that administrator or facility staff neglected the clients in care.

Allegation: Staff did not meet incontinence needs of residents/clients resulting to septic shock

Based on interview, staff are changing diapers as needed. Interview with staff reveal that clients are check every 2-3 hours for incontinence care. Staff stated that client/s would be cleaned and sometimes showered after an accident on top of the regular showers scheduled for clients in care. Although C1, C3 & C6 was diagnosed of septic shock, there were no indication of the cause and records review did not indicate that this was due to facility failed to meet incontinence needs of the clients.

Allegation: Staff yelled in front of resident(s).

LPA conducted interviews with clients and staff. LPA tried to interview clients in care but the clients are non-verbal and did not respond to any of the interview questions. Staff denied yelling at the residents or clients in care and denied knowing any incident/s of yelling towards the clients.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie Ibo	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC9099 (FAS) - (06/04)

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