197602540-10-21-2025-31-AS-MGFS-DVP4G7-20260704190500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602540
Report Date: 10/21/2025
Date Signed: 10/21/2025 05:03:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250312150540

FACILITY NAME:	BELLAMAR LANCASTER		FACILITY NUMBER:	197602540
ADMINISTRATOR:	ANALILIA ZARZGOZA		FACILITY TYPE:	740
ADDRESS:	43454 30TH STREET WEST		TELEPHONE:	(661) 949-2177
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	68	CENSUS: 44	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Kortnie Spitznogle - Excutive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained unexplained lacerations.

INVESTIGATION FINDINGS:

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On 10/21/2025 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced subsequent complaint visit to deliver findings on the above-mentioned allegation. LPA met with Kortnie Spitznogle - Executive Director and explained the reason for the visit.

Allegation: Resident sustained unexplained lacerations. Regarding the allegation it was reported that Resident #1 (R1) has deep lacerations on both of their lower legs. To investigate the allegation LPA Rios conducted an initial unannounced complaint investigation on 03/14/2025 at 12:05 p.m., LPA requested a resident and staff roster. At approximately 12:30 p.m., LPA conducted a physical plant tour, to ensure health and safety of the residents in care. From 12:39 p.m. to 1:20 p.m., LPA interviewed seven (7) residents, resident #1's (R1's) family member and one (1) staff.

(Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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 31-AS-20250312150540

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELLAMAR LANCASTER	FACILITY NUMBER: 197602540
	VISIT DATE: 10/21/2025

NARRATIVE

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(Continued from LIC9099) At 1:30 p.m., LPA requested copies of pertinent information relevant to the investigation which include the following records for R1, Physician’s reports, Appraisal Needs and Services Plans, Hospital Discharge Instructions and staff statements when R1 was observed with injuries. From 2:04 p.m. to 3:33 p.m. LPA conducted interviews with four (4) staff, the Executive Director, Kortnie Spitznogle and the Resident Care Director Jesse Wong. LPA's review of records revealed R1 was taken to the emergency room on 03/12/2025 and was discharged with one laceration on their lower right leg and one laceration on their lower left leg.

LPA attempted to interview Resident 1 (R1). R1 greeted the LPA with a smile but did not respond to any questions. LPA observed R1 seated in a wheelchair with bandages wrapped around both legs, extending from the ankles to just below the knees. Interviews conducted with R1’s family member revealed no concerns regarding the care provided. They believed the injuries were accidental and not related to staff conduct. Interviews with five (5) staff members indicated they were unaware of how R1 sustained the injuries. They speculated the injuries may have resulted from R1’s pre-existing leg condition but did not express concerns about staff involvement.

The Executive Director speculated that R1 may have attempted to get out of bed, and their lower legs came into contact with a part of the bed frame, causing the lacerations. LPA observed the bed frame, did have a metal bar running along the bottom to secure the mattress. Furthermore, LPA observed blood on the bedsheet and carpet near the bed frame bar, as well as a larger concentration of blood in the area where staff reported repositioning R1’s legs to help them sit upright. LPA did not observed any hazards in R1's room. According to both the Executive Director and R1’s family, the bed was brought in by the family. Interviews with six (6) out of seven (7) residents revealed no concerns regarding the care provided. Two (2) out of those seven (7) interviewed who, have rooms near R1 reported not hearing anything unusual on the day of the incident.The bed has been since been removed as of today's visit.

R1 was unable to explain how they got the lacerations and LPA was unable to locate a witnesses to the incident. Based on record reviews, staff and resident interviews, this allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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