107208989-10-18-2021-24-AS-MHON-C7WVST-20211018164205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208989
Report Date: 10/18/2021
Date Signed: 10/18/2021 11:46:47 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2021 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210810143633

FACILITY NAME:	BELLA CARE HOME LLC-MATUS		FACILITY NUMBER:	107208989
ADMINISTRATOR:	GONZALES, MARILEN		FACILITY TYPE:	740
ADDRESS:	7947 NORTH MATUS AVE		TELEPHONE:	(559) 259-6228
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 6	DATE:	10/18/2021
		UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Administrator, Marilen Gonzalez		TIME COMPLETED:	10:57 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff yells at residents in care
Centrally stored medications are accessible to residents in care
Staff do not have appropriate training
Facility is unkempt

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/18/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Marilen Gonzales.

During this investigation, LPA reviewed records, conducted a facility tour, and interviewed residents and staff.

Interviews with staff revealed that S1 can speak in a tone that “may be seen as rude”. Per Administrator, S1 “can get excited and speak in a high tone”. S1 does not yell or verbally abuse residents in care. Interviews with residents revealed that there were no concerns with staff.

CONTINUED TO LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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 24-AS-20210810143633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BELLA CARE HOME LLC-MATUS	FACILITY NUMBER: 107208989
	VISIT DATE: 10/18/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on record review and interviews with staff, it was determined that staff have received the required training prior to working with residents. Interviews revealed that the Licensee instructs staff training. New hires are trained for approximately 2 weeks, training includes shadowing other caregivers.

During the facility tour, LPA observed medications to be stored inaccessible to residents in care, in a cabinet in the kitchen. LPA did not observe medications in the resident bedrooms. Facility floors appeared to be clean during the inspection, no residue or dirt was observed on the floors. Faucets were observed to be operational, LPA observed faucets to be in good repair. Resident bedrooms were observed to be kempt, with no obstructions to pathways. Resident bathrooms were observed to be clean and free from odors.

Based on observation, interviews and records review, 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.

No deficiencies issued.

An exit interview was conducted with Administrator. As a COVID-19 precautionary measure, copy of this report was discussed and provided to Administrator via email and an electronic read receipt confirms receiving this document. Report was signed on-site by Facility Representative.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2