197606597-3-25-2022-31-AS-MVAO-CMRQGC-20230104110917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606597
Report Date: 03/25/2022
Date Signed: 03/25/2022 05:22:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/09/2020 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20201109145023

FACILITY NAME:	WESTPORT HOME		FACILITY NUMBER:	197606597
ADMINISTRATOR:	MORENA MARTINEZ		FACILITY TYPE:	740
ADDRESS:	10252 EAST AVENUE S		TELEPHONE:	(661) 944-5779
CITY:	LITTLEROCK	STATE: CA	ZIP CODE:	93543
CAPACITY:	20	CENSUS: 12	DATE:	03/25/2022
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Teodora Cambiado		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Bathrooms did not contain paper towels for residents' and staff members' use

Residents not wearing masks when walking throughout the facility.

Residents were not practicing social distancing while eating meals within the dining area.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Spaeth conducted a visit with Facility Manager, T. Cambiado. LPA Spaeth explained the purpose of the visit is to provide LPA Spaeth’s findings regarding the allegations bathrooms did not contain paper towels for residents' and staff mebmers' use, residents were not practicing social distancing while eating meals within the dining area, and some residents were not wearing masks when walking throughout the facility.

Bathrooms did not contain paper towels for residents' and staff member's use.

LPA Spaeth conducted a FaceTime visit on November 12, 2020. LPA Spaeth viewed the five bathrooms and observed all restrooms contained paper towel dispensers which contained paper towels. LPA Spaeth also observed each bathroom contained hand soap, trash can, and wash your hands signs. Therefore the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

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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Control Number 31-AS-20201109145023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WESTPORT HOME	FACILITY NUMBER: 197606597
	VISIT DATE: 03/25/2022

NARRATIVE

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Residents were not wearing masks when walking throughout the facility.

During LPA’s November 12, 2020 FaceTime visit, LPA observed a resident sitting at the dining room table who was not wearing a mask but was eating a meal. LPA observed two other residents who were walking down the hallway and were wearing masks. There also was a resident who was not wearing a mask but LPA observed Administrator reminded resident to put on mask. Therefore the allegation some residents were not wearing masks when walking throughout the facility is unsubstantiated.

Residents were not practicing social distancing while eating meals within the dining area.

During LPA’s November 12, 2020 FaceTime visit, LPA observed three dining tables in the dining area; however there were six chairs at each table. LPA explained the social distancing recommendations during meals for residents. LPA Spaeth spoke to Administrator on the evening of November 12, 2020 at 6:00 pm who stated there were three time slots for each meals that were set up and explained to residents so that social distancing could be implemented. LPA observed two residents in the dining area and were social distanced. Therefore the allegation is unsubstantiated.

Exit interview conducted, appeal rights discussed, and a copy of the signed report was given to the facility manager.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022

LIC9099 (FAS) - (06/04)

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