197609839-7-26-2024-31-AS-TAGD-D7WP3E-20240807105722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609839
Report Date: 07/26/2024
Date Signed: 07/26/2024 04:06:36 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.ASC, 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
08/01/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230801095955

FACILITY NAME:	CASA AMORE WEST		FACILITY NUMBER:	197609839
ADMINISTRATOR:	TORTORICI, MARGARITA		FACILITY TYPE:	740
ADDRESS:	1715 LAKE WAY		TELEPHONE:	(661) 522-3259
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 4	DATE:	07/26/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lilia Gaitan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Illegal eviction.
Licensee denied Ombudsman to visit with resident.
Licensee did not ensure resident is provided proper resources upon discharge.

INVESTIGATION FINDINGS:

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On 7/26/2024 Licensing Program Analyst (LPA), Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by a staff member. LPA Spaeth sopke to the Administrator, Rita Morales by phone at 10:15 am. LPA explained the purpose of this visit was to present findings.

LPA conducted a physical tour at 10:30 am until 10:20 am. LPA did not observe any health or safety issues. LPA Spaeth reviewed resident records at 10:30 until 10:45 am. LPA Spaeth interviewed four staff members and the Licensee at 11:00 am until 12:00 noon.

The investigation consisted of the following: On 08/07/2023 LPA Spaeth initiated a complaint investigation for the allegation(s) listed above. LPA Spaeth requested documentation.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20230801095955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CASA AMORE WEST	FACILITY NUMBER: 197609839
	VISIT DATE: 07/26/2024

NARRATIVE

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Regarding the allegation: illegal eviction. It’s being alleged that a resident (R1) was not given a written eviction notice. LPA Spaeth interviewed the Licensee who stated a written eviction notice was not given to R1. The Licensee stated R1 temporarily moved into the facility after being hospitalized. R1 was living at the facility until R1's apartment had been renovated. Three (3) out of the four (4) staff members confirmed a written eviction notice was not given to R1. R1 no longer lives at the facility and LPA Spaeth was unable to contact R1. LPA Spaeth interviewed one (1) out of the four residents. R2 stated has never received an eviction notice. R3 and R4 were asleep during LPA's visit. R5 was unable to answer questions but R5's family member was interviewed at 2:30 pm who stated staff have never issued an eviction notice to R5. Based upon LPA's interview of staff, resident and a resident's family member, the allegation is unsubstantiated.

Regarding the allegation: Licensee denied Ombudsman to visit with resident.. It’s being alleged that when the Ombudsman met with R1 at the facility, the Licensee yelled at the Ombudsman via phone call and told the Ombudsman to leave the facility. The Licensee stated they did not yell at the Ombudsman. The Licensee stated they received a call from the Administrator. The Licensee stated they could hear the Ombudsman in the background raising their voice when speaking to the Administrator. The Licensee spoke to the Ombudsman, allowed the Ombudsman to speak but then asked the Ombudsman to stop yelling. The Ombudsman became upset and continued to yell. The Licensee then told the Ombudsman to leave because the Ombudsman was upsetting the residents. LPA Spaeth interviewed the Administrator at 11:00 am and a staff member (S1) at 11:30 am who confirmed the Ombudsman was personally speaking with R1 in R1's room. The Administrator and S1 both stated the Obudsman.came out of R1's room and was yelling at the Administrator and accused the Administrator of illegally evicting R1. Both confirmed a resident who was sitting in the living room became upset when the Ombudsman was yelling. Both confirmed the Licensee was called and the Ombudsman was asked to leave.. The Administrator confirmed they did not yell at the Ombudsman and S1 confirmed the Administrator was calm and remained professional. Based upon LPA's interviews, the allegation is unsubstantiated.

Regarding the allegation: Licensee did not ensure resident is provided proper resources upon discharge. It’s being alleged the facility staff did not provide R1 transportation to their doctor’s appointment and transportation to arrange IHSS services. S1, S2, S3, and S4, the Licensee and Administrator all confirmed the resident was provided transportation to doctor's appointments, IHSS services, and other

continued on 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230801095955

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CASA AMORE WEST	FACILITY NUMBER: 197609839
	VISIT DATE: 07/26/2024

NARRATIVE

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personal business needs. S3 stated they made sure R1's apartment was set up before R1 moved back to their apartment. S1 - S4 all confirmed they even provided meals to R1 when R1 moved into their apartment. LPA Spaeth interviewed one (1) out of the four residents. R2 stated staff has assisted R2 with all their doctor's appointments and personal appointments. R3 and R4 were asleep during LPA's visit. R5 was unable to answer questions but R5's family member was interviewed and stated staff have never refused to assist R5 with doctor's appointments. Based upon LPA's interview of staff, the resident and the resident's family member, the allegation is unsubstantiated.

LPA Spaeth read the report to the Licensee at 2:45 pm via phone call. The Licensee confirmed the staff member can sign the report.

Exit interview conducted, a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024

LIC9099 (FAS) - (06/04)

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