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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011440834
Report Date: 08/19/2020
Date Signed: 08/19/2020 12:27:55 PM



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
10/25/2019 and conducted by Evaluator Treana White
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20191025150331
FACILITY NAME:ST. REGIS RETIREMENT CENTER, INC.FACILITY NUMBER:
011440834
ADMINISTRATOR:CHINIKAMWALA, SHABBIRFACILITY TYPE:
740
ADDRESS:23950 MISSION BLVD.TELEPHONE:
(510) 881-7888
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:194CENSUS: 69DATE:
08/19/2020
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Shabbir Chinikamwala, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff failed to meet resident's hygiene/grooming needs
Staff neglect resulting in resident developing an infection
INVESTIGATION FINDINGS:
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On 08/19/2020, Licensing Program Analyst (LPA) T. White called the facility to deliver the complaint findings for the above allegations. LPA spoke with Executive Director, Shabbir Chinikamwala. LPA explained due to the present shelter in place order by the Governor, the notification of the complaint is being done over the phone.

During the course of investigation, the caseload LPA conducted interviews and collected documentation in relation to the complaint. Based on interview conducted by caseload LPA with R1’s podiatrist, podiatrist states that he sees R1 every 2-3 months to check on R1’s feet including toenails. Caseload LPA observed during interview that R1’s toenails were appropriately trimmed. However, while observing R1’s feet, LPA noticed a strong odor smell coming from R1’s feet and slippers.

Report Continues on 9099C>
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
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 2
Control Number 15-AS-20191025150331
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: ST. REGIS RETIREMENT CENTER, INC.
FACILITY NUMBER: 011440834
VISIT DATE: 08/19/2020
NARRATIVE
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Based on interviews conducted, R1 developed fungal infection while at the facility. Staff notified podiatrist about it. When caseload LPA spoke with podiatrist, he states that he is aware of the fungal infection and has been treating it. He added that toenail fungal infection is not life threatening because it stays in the nails unlike bacterial infection which can be fatal. Based on interviews and records reviewed, the above allegations are unsubstantiated.

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

Exit interview conducted with Executive Director and a copy of report emailed to facility.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2