157209146-4-12-2024-24-AS-SPIY-D4FNG9-20240418102646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209146
Report Date: 04/03/2024
Date Signed: 04/12/2024 01:16:51 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, 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
01/29/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240129151358

FACILITY NAME:	QUALITY CARE ASSISTED LIVING		FACILITY NUMBER:	157209146
ADMINISTRATOR:	ESPINAL, ALMA		FACILITY TYPE:	740
ADDRESS:	2607 MT. VERNON AVENUE		TELEPHONE:	(661) 871-8133
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY:	54	CENSUS: 43	DATE:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Staff Paula Maribel Brizuela		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Staff did not ensure that resident's toileting needs are met
Staff did not safeguard resident’s personal belongings

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. LPA explained the purpose of the visit. Staff Paula Maribel Brizuela advised the Administrator is currently out of the country.

LPA toured the facilty. LPA interviewed staff. Facility staff stated R1 did not have a roommate. Resident no longer resides at the facility. LPA requested a copy of R1's file. LPA reviewed the property list.

Based on interviews and records review, it is not determined whether or not Staff did not ensure that resident's toileting needs are met and if Staff did not safeguard resident’s personal belongings. Although the allegation 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 allegation is UNSUBSTANTIATED.

A copy of this report was provided to Administrator via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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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