191600093-11-17-2023-11-AS-MVAO-CZ6US6-20240104144948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 11/17/2023
Date Signed: 11/17/2023 03:11:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/14/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20231114162449

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: 60	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Rodolfo Dimatulac		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are allowing smoking indoors at the facility.
Facility has pets.
Staff illegally opened resident's mail.
Staff stole resident's mail.
Facility is incorrectly billing resident for their expenses.

INVESTIGATION FINDINGS:

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On 11/17/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to deliver findings regarding the above allegations. LPA Richard met with Administrator Rodolfo Dimatulac and explained the reason for the visit.

The investigation consisted of the following:
On 11/17/2023, LPA Richard toured the facility inside and out with administrator Dimatulac
LPA Richard reviewed and requested, staff and resident's records. LPA interviewed seven clients (C1-C7), and six staff (S1-S6). LPA Richard requested, reviewed and collected facility documents.

This report is cotinued, please see LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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-20231114162449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BAY BREEZE CARE	FACILITY NUMBER: 191600093
	VISIT DATE: 11/17/2023

NARRATIVE

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Investigation revealed the following:

Regarding allegation: Staff are allowing smoking indoors at the facility.

On 11/17/2023, LPA interviewed staff S1-S6 about the allegation above, and all staff denied the allegation. The staff also stated they forcefully told the client to go outside to smoke. Smoking is not allowed inside the facility. LPA Richard interviewed clients C1- C7, and all clients stated that they did not see anyone smoke inside but outside in front or in the back of the facility.

Based on LPA interviews, LPA did not find sufficient evidence to support the allegation, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation staff are allowing smoking indoors at the facility is UNSUBSTANTIATED.

Regarding allegations: Facility has pests.

On 11/17/23, LPA interviewed staff S1-S6 about the allegation above, all 6 staff agreed the allegation is not true. The client's room did not have bedbugs. The staff also reported if a client reports that they have noticed bed bugs in their room the staff immediately spray bed bug spray and call the exterminator. LPA interviewed clients C1-C7. 6 out 7 clients stated they did not observe beg bugs in their rooms. During today investigations, LPA, Administrator and housekeeper did not observe bedbugs in Clients C1, C7. However, the administrator called the exterminator orkin to come and spray some of the client's room.

Based on LPA observation and interviews there is no sufficient evidence to support the above allegation, although the allegation may have happened or is valid, there is no preponderance of evidence to prove alleged violation did or did not occur, therefore the allegation facility has pests is unsubstantiated

Regarding allegation: Staff illegally opened resident mail.

On 11/17/23, LPA interviewed staff S1-S6 about the allegation above, and all staff denied the allegation. Staff stated they do not illegally opened resident mail. Staff S1(Adm) stated the reason he opened client C1 mail is because he was waiting for a SSI check for C1. When the check came it looked the same as all the checks the facility receive for all the clients. We stamp the check as we do for all the clients' SSI and we deposit it automatically from our office. On 11/03/23, staff S1 notify the client C1 about the check while S1 was driving C1 to the bank. LPA interviewed clients C1-C7. 6 out 7 clients stated they were okay with how the staff gives them their mail. Clients stated they never had any problem receiving their mail.

Based on LPA interviews, and records reviewed, LPA did not find sufficient evidence to support the allegation, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation staff illegally opened resident mail is UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231114162449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BAY BREEZE CARE	FACILITY NUMBER: 191600093
	VISIT DATE: 11/17/2023

NARRATIVE

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Regarding allegations: Staff stole resident's mail..

On 11/17/23, LPA interviewed staff S1-S6 about the allegation above, and all staff denied the allegation; 6 out of 6 staff stated that the clients never complained about missing their mail. Staff stated the office screens the mail for insurance cards,and SSI. LPA interviewed Clients C1-C7 about the allegation above and all the clients denied, however 1 out of 7 clients stated that didn't like the way staff talked about the mail.

Based on LPA interviews LPA did not find sufficient evidence to support the allegation, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation Staff stole resident's mail, is UNSUBSTANTIATED.

Regarding allegations: Facility is incorrectly billing resident for their expenses.

On 11/17/23, LPA interviewed staff S1-S6 about the allegation above, and all staff denied the allegation; 3 out of 6 staff stated that they don't know anything about billing clients. Staff S1 (Adm) stated all the clients have the same billing expenses except Medical and Medicare clients and the facility charged an extra twenty dollars. LPA reviewed client C1- C7 and did not see any incorrect billing.

Based on LPA interviews, records reviews, LPA did not find sufficient evidence to support the allegation, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation Facility is incorrectly billing resident for their expenses is UNSUBSTANTIATED.

Exit interview conducted. A copy of the report and Confidential Names LIC811 were provided to Rodolfo Dimatulac the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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