191600093-12-8-2023-11-AS-MVAO-CZ52F7-20240102162104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 12/07/2023
Date Signed: 12/08/2023 10:03:39 AM

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
11/30/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20231130111048

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: 56	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rodolfo Dimatulac		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, December 07, 2023, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Administrator Rodolfo Dimatulac. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews with staff members 1-3 (S1-S3) and residents 2-6 (R2-R6). Resident 1 (R1) was no longer present at the facility, and thus, LPA Bunker was unable to conduct an interview with him. According to the statements from S1-S3, there were no instances of illegal eviction notices being issued by the facility staff to any residents. LPA Bunker thoroughly reviewed R1's records and requested copies of relevant supporting documents for a detailed analysis. It was clarified by S1-S3 that the decision to move Resident 1 from the facility was taken by R1's Public Guardian and Crisis Management team, indicating that the facility had no direct control over the relocation process of R1.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231130111048

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: 12/07/2023

NARRATIVE

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Continued LIC9099-C page 2
S1-S3 confirmed that all pertinent information regarding this matter was promptly reported to Community Care Licensing and all other relevant agencies, ensuring compliance and transparency in their operations.
Allegation: Illegal eviction. In response to this, allegation interviews were conducted with both staff members (S1-S3) and residents (R2-R5). The collective feedback from these interviews unanimously indicated no issues concerning an illegal eviction notice. Residents (R2-R5) expressed their satisfaction with living at the facility, highlighting the respect, dignity, and quality of care they receive. They also commended the facility for providing a secure, healthful, and comfortable living environment and they were happy. S1-S3 refuted the allegation, reinforcing the commitment to safety and well-being upheld at the facility.

Investigation revealed the following: During interviews, staff members S1-S3 uniformly asserted that no resident, including Resident 1 (R1), received an illegal eviction notice. It was specifically mentioned by S1-S3 that R1 was involved in an incident where a staff member was injured, not another resident. The incident resulted in the staff member sustaining a nose injury with bleeding. S3 immediately responded by calling 911, leading to the intervention of the Paramedic, the Long Beach Mental Evaluation Team, and the Long Beach Police Department. R1 was placed on a 5150 hold for a psychological evaluation and possible medication adjustment. S1-S3 stated the facility did not refuse to readmit R1 following the release from the 5150 hold. R1 underwent a reassessment, and the facility was actively coordinating with R1's Public Guardian regarding the next steps. The ultimate decision not to allow R1's return to the facility was made jointly by R1's Public Guardian, Primary Physician, and the Crisis Management Team, citing the need for a higher level of care. S1-S3 emphasized that R1 was never evicted, and no eviction notice was issued by the facility. Staff reported the incident to all relevant agencies in a timely manner, adhering to the required protocols. Regarding the relocation of R1, S1-S3 highlighted that the decision was made by R1's Public Guardian and the Crisis Management Team. The facility had no control over this process due to R1 being conserved. S1-S3 reiterated their awareness and understanding of Title 22 Regulation concerning eviction procedures and denied any allegations to the contrary. They also affirmed their commitment to maintaining open communication lines, ensuring all incoming calls are answered and returned promptly.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to the Administrator. There were no deficiencies cited. Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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