157209146-4-22-2024-24-AS-SPIY-D6ELEA-20240620084110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209146
Report Date: 04/22/2024
Date Signed: 04/22/2024 11:16:19 AM

Substantiated

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
04/17/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240417130037

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: 41	DATE:	04/22/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Staff Paula Maribel Brizuela		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unqualified staff providing care and supervision.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
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 contacted Administrator Ria Loria via telephone who gave permission for Staff Paula Maribel Brizuela to sign for the report.

LPA interviewed staff and residents. LPA toured the facility. LPA reviewed staff file for S1. LPA obtained a copy of the staff schedule and the resident roster.

LPA reviewed staff schedule and found S1 is working in the facility on 4/17/24, 4/19/24 and 4/20/24 and is not associated to the facility. LPA reviewed S1's file, which only consisted of the LIC 501. Facility did not have any other information for S1.

Substantiated

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: 04/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024

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 5

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
04/17/2024 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20240417130037

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: 41	DATE:	04/22/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Staff Paula Maribel Brizuela		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not following the menu.
Staff do not provide adequate amount of food to residents.
Staff speaks to residents inappropriately.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
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 contacted Administrator Ria Loria via telephone who gave permission for Staff Paula Maribel Brizuela to sign for the report.

LPA interviewed staff and residents.

During the tour of the facility LPA checked the food and the menu. Facility is not serving food that matches the menu. Lunch menu states residents are having meat loaf for lunch. Kitchen staff stated residents are having grilled cheese. Facility does not have enough fresh fruits or vegetables for the amount of residents.
This was cited on complaint number 24-AS-20240116151446 and the plan of correction is due by 4/26/24.

During the course of the investigation it was found facility does not have activities or an Activities Director for the residents.

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: 04/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 24-AS-20240417130037

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: QUALITY CARE ASSISTED LIVING	FACILITY NUMBER: 157209146
	VISIT DATE: 04/22/2024

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 interviews, observations and records review, 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.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 24-AS-20240417130037

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: QUALITY CARE ASSISTED LIVING	FACILITY NUMBER: 157209146
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/23/2024 Section Cited HSC 1522(C)	1 2 3 4 5 6 7	1522 Fingerprints and criminal records; exemptions; criminal record clearances (C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the community care facility. The facility shall maintain the copy of the certification on file as long as care is being provided by the certified nurse assistant or certified home health aide at the facility or in a certified family home or resource family home of a foster family agency. This paragraph does not restrict the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed community care facility or certified family home or resource family home of a foster family agency pursuant to Section 1558.	1 2 3 4 5 6 7	Plan of Correction POC Licensee agrees to associate S1 to the facility by POC due date 04/23/24. Licensee will submit proof of association. Civil Penalty issued
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 24-AS-20240417130037

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: QUALITY CARE ASSISTED LIVING	FACILITY NUMBER: 157209146
	VISIT DATE: 04/22/2024

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 the Departments interviews and records review S1 worked in the facility on 4/17/24, 04/19/24 and 4/20/24, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D.

Civil Penalty was issued.

Refer to 809 and 809D for additional deficiencies observed during visit.

A copy of the this report was provided to the Administrator with appeal rights and plan of correction.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5