079200381-9-29-2021-15-AS-KHOS-C7XMV9-20211019095621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079200381
Report Date: 09/29/2021
Date Signed: 09/29/2021 04:49:05 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
12/09/2020 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20201209145538

FACILITY NAME:	GOLDEN AURORA HEALTHCARE INC.		FACILITY NUMBER:	079200381
ADMINISTRATOR:	MARIA THERESA B RIVERA		FACILITY TYPE:	735
ADDRESS:	2709 VISTA COURT		TELEPHONE:	(408) 207-5172
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	6	CENSUS: 6	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Maria Rivera, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident was not accorded the right to control his/her own cash resources.

Staff yelled at resident.

Resident was not accorded the right to have access to a telephone in order to make and receive confidential calls

Resident was not accorded dignity in relationships with staff.

INVESTIGATION FINDINGS:

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On 09/29/2021 at 02:30PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to investigate and deliver complaint findings for the above allegations. LPA met with Maria Rivera, Administrator, and explained the reason for the visit.

During the course of the investigation, LPA conducted interviews with two (2) of three (3) staff, four (4) of six (6) clients, Reporting Party (RP), obtained and reviewed documents. Interview and document review indicated that C1 spends money for what is wanted. Staff maintains P&I. LPA counted money and observed receipts. P & I document matched money that was counted by LPA.

Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 15-AS-20201209145538

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: GOLDEN AURORA HEALTHCARE INC.	FACILITY NUMBER: 079200381
	VISIT DATE: 09/29/2021

NARRATIVE

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Continued from LIC9099.

On the allegation staff yelled at resident. Clients denied during interviews that staff yells or speaks inappropriately to them. Staff indicated during interview that they are trained to handle situations in a calm manner and not to yell at clients.

On the allegation resident was not accorded the right to have access to a telephone in order to make and receive confidential calls. C1 has personal iPhone. C1 stated that C1 uses facility phone for doctor's call, but uses personal cell phone for all other calls. Staff stated clients are able to use facility phone if needed, but clients have personal cell phones. LPA observed four (4) of six (6) clients with cell phones in their hands.

On the allegation resident was not accorded dignity in relationships with staff. C1 had moved out of the facility in February 2021 and moved back into the facility May 2021. C1 requested to return to facility. C1 stated that staff is very nice and gives assistance if needed.

LPA reviewed the following documents but was not able to obtain copies. Administrator will submit a copy of the facility roster, staff schedule, admission agreement, and Individual Program Plan (IPP) to CCLD by 10/1/2021.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conduct and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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