157209146-11-1-2022-24-AS-SPIY-CPBLFC-20230223074256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209146
Report Date: 11/01/2022
Date Signed: 11/01/2022 04:35:10 PM

Unfounded

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
04/04/2022 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220404132517

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:	DATE:	11/01/2022
		UNANNOUNCED	TIME BEGAN:	04:05 PM
MET WITH:	Maribel Brizuela		TIME COMPLETED:	05:36 PM

ALLEGATION(S):

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Resident became ill from facility’s food.
Staff putting something in resident’s food/drink.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with Maribel Brizuela, staff and informed her the purpose of the visit.

During the course of this investigation LPA reviewed facility files and interview of staff relevant to the complaint investigation. It was determined that the above allegations: Resident became ill from facility’s food, and Staff putting something in resident’s food/drink are UNFOUNDED. During the investigation, the file review and interviews indicated he wasn't sick from the facility food and/or staff putting anything into his food/drink. This agency has investigated the complaint alleging (Resident became ill from facility’s food, and Staff putting something in resident’s food/drink). We have found that the complaint was unfounded, therefore we have dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Les Xiong	TELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022

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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