191600093-8-30-2023-11-AS-RORN-CWPMYQ-20231017100156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 08/30/2023
Date Signed: 08/30/2023 02:14:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230823154059

FACILITY NAME:	BAY BREEZE CARE		FACILITY NUMBER:	191600093
ADMINISTRATOR:	DIMATULAC, RODOLFO		FACILITY TYPE:	735
ADDRESS:	1653- 55 SANTA FE AVE		TELEPHONE:	(562) 432-8033
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	76	CENSUS: 72	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Rodolfo Dimatulac		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff hit resident with an object.
Staff spoke to resident in an inappropriate manner.
Staff does not treat resident with dignity or respect.

INVESTIGATION FINDINGS:

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On 08/30/23, at 10:00am, Licensing Program Analyst (LPA), Perry Scott conducted a 10-day complaint investigation at the facility listed above. LPA met with Rodolfo Dimatulac, Administrator, and explained the purpose of today’s visit was to investigate the allegations listed above.

On 08/30/23, the investigation consisted of the following:

During today's visit LPA toured the facility. LPA requested and obtained copies of the following documents: Resident and Staff Roster, Record of Client’s/Resident’s Safeguarded Cash Resources, Basic Fact Sheet, Incident Reports, Physician’s Report, Individual Service Plan, and Appraisal/Needs and Service plan for C1. LPA interviewed staff (S1-S5) and clients (C1-C10).

The investigation revealed the following: Regarding allegation #1: Staff hit resident with an object.

On 08/30/23, at 11:00am-01:30pm, LPA interviewed S1-S5. 5 of 5 staff denied the allegation that Staff hit resident with an object. All staff stated that they never hit clients, they only counsel them when their behavior becomes concerning. After that they contact the public guardian and their conservators about their behavior. LPA interviewed C1-C10, and 9 of 10 clients denied that they witnessed staff threatening or touching clients inappropriately.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 11-AS-20230823154059

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BAY BREEZE CARE	FACILITY NUMBER: 191600093
	VISIT DATE: 08/30/2023

NARRATIVE

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Based on interviews, there is insufficient evidence to support the allegation: Staff hit resident with an object. 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.

Allegation #2: Staff spoke to resident in an inappropriate manner.

On 08/30/23, at 11:00am-01:30pm, LPA interviewed S1-S5. 4 of 5 staff denied the allegation that Staff spoke to resident in an inappropriate manner. Most of the staff state that the staff never speaks to the clients in an inappropriate manner. LPA interviewed C1-C10. 9 of 10 clients denied that staff speaks to them in an inappropriate manner. Further, 9 of 10 clients state that they feel safe in the facility.

Based on interviews, there is insufficient evidence to support the allegation: Staff spoke to resident in an inappropriate manner. 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.

Allegation #3: Staff does not treat resident with dignity or respect.

On 08/30/23, at 11:00am-01:30pm, LPA interviewed S1-S5. 4 of 5 staff denied the allegation that Staff does not treat resident with dignity or respect. Most of the staff state that they treat the clients with dignity and respect. They state that they don’t yell, harass, threaten, or bully clients in any way that would disrespect them. LPA interviewed C1-C10. 9 of 10 clients stated that they are treated with dignity and respect and like living in the facility.

Based on interviews, there is insufficient evidence to support the allegation Staff does not treat resident with dignity or respect. 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.

No deficiencies were cited.

An exit interview was conducted, and a hard copy of this report was provided to Rodolfo Dimatulac, Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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