079201007-12-5-2024-15-AS-BFOG-DCQSBN-20250108124413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 079201007
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:27:44 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
08/13/2024 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20240813125832

FACILITY NAME:	BELTRAN'S PLACE		FACILITY NUMBER:	079201007
ADMINISTRATOR:	RODRIGUEZ, RENE ELIAS		FACILITY TYPE:	735
ADDRESS:	4645 APPLEGLEN ST		TELEPHONE:	(904) 859-1773
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	6	CENSUS: 5	DATE:	12/05/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Rene Rodriguez, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff are selling drugs out of the facility
Staff speak inappropriately to residents
Staff are not providing adequate food service

INVESTIGATION FINDINGS:

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On 12/05/24 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with administrator (ADM) to deliver the findings of above allegations. LPA explained the purpose of the visit with ADM.

During investigation, the department conducted interviews and obtained the following documents from administrator – Clients’ roster with contact information, Staff roster with contact information, Personnel Record (LIC500) / Work Schedules, Admission agreements, centrally stored medications & medication administration records (MARs), incident reports, meal schedules, Needs & Services plans, physicians’ reports.

Continued on next page, LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

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-20240813125832

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: BELTRAN'S PLACE	FACILITY NUMBER: 079201007
	VISIT DATE: 12/05/2024

NARRATIVE

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Allegation: Staff are selling drugs out of the facility
Investigation Finding: Unsubstantiated
During investigation, clients (C1, C2, C3) confirmed with LPA that they receive their daily prescribed medications from staff as ordered by their primary care physicians (PCPs). Staff (ADM, S1, S2) denied selling any clients’ prescription medications out of the facility. Review of each client’s centrally stored medication records and medication administration logs (MARs) from January 2024 to August 2024 show each client’s prescribed medications were administered by staff as ordered by their PCPs and medication refills made by their respective pharmacies. Although the allegation that staff are selling drugs out of the facility may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, this allegation is unsubstantiated.

Allegation: Staff speak inappropriately to residents
Investigation Finding: Unsubstantiated
During investigation, clients (C1, C2, C3) confirmed with LPA that staff (ADM, S1,S2, S3) do not yell, swear, threaten or verbally abuse them. Staff stated they treat all clients with dignity and respect. Clients (stated staff treat them well and do not abuse them verbally or physically. On 08/14/24, LPA observed staff not using any swear words when talking with clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff speak inappropriately to residents is unsubstantiated.

Continued on next page, LIC 9099-C pg1

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240813125832

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: BELTRAN'S PLACE	FACILITY NUMBER: 079201007
	VISIT DATE: 12/05/2024

NARRATIVE

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Allegation: Staff are not providing adequate food service
Investigation Finding: Unsubstantiated
During investigation, LPA interviewed clients (C1, C2, C3) who stated that staff provide them 3 meals and snacks with drinks daily. Clients stated they can get additional 7-day non-perishable snacks stored in personalized containers inside the garage if they are still hungry or purchase take-out food whenever they want. During visit on 08/14/24, LPA observed facility has a 7-day supply of non-perishables and 2-day supply of perishable foods. LPA observed boxes of cereals, milk, fresh fruits, hot pockets, juices, frozen meats (hot dogs, chicken, hamburgers, fish fillets, potato fries, pastas available in the kitchen refrigerator/freezer/pantry/kitchen island areas. Review of facility’s weekly meal menus show a variety of food and snacks prepared for clients. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff are not providing adequate food service is unsubstantiated.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC9099 (FAS) - (06/04)

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