197609853-12-1-2023-31-AS-MVAO-D223N8-20240131172331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609853
Report Date: 12/01/2023
Date Signed: 12/01/2023 02:24:07 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
11/21/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20231121123001

FACILITY NAME:	REESEJOY CARE HOME II		FACILITY NUMBER:	197609853
ADMINISTRATOR:	RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	17544 SAN JOSE ST		TELEPHONE:	(805) 832-8792
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS:	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Carmelita Aliga		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff is not following resident's dietary plan.
Staff is withholding resident's medication.
Staff is not providing utensils when serving meals to a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with staff, Carmelita Aliga, and advised her of the complaint. Today's investigation consisted of resident and staff interviews, a review of facility records, a review of the facility food service and inspection of the physical plant.

Staff is not following resient's dietary plan:
In regards to the allegation, it was alleged that Resident 1 (R1) requires a special diet, but staff is using too much salt on R1's food and serving food that R1 cannot have. Interviews with staff and residents made at approximately 9:15am to 10:30am. Interviews with staff deny the allegation. Interviews with two of two residents also do not corroborate with the allegation. Interview with R1 reveal that they have a special meal, prepared and delivered to them weekly from Project Angel Food. These meals consists of

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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 31-AS-20231121123001

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: REESEJOY CARE HOME II	FACILITY NUMBER: 197609853
	VISIT DATE: 12/01/2023

NARRATIVE

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either chicken, turkey or shredded pork, vegetables, green beans or peas. Meals are specifically ordered by R1 or their family member, and delivered to the facility every Monday, that is good for the week. Also, alternate meals are prepared for R1, but denies steak or food with high sodium is ever served to them. At approximately 10:40am to 11:40am, a review of facility records were made. Record review reveal that R1 does require a low sodium and diabetic diet, which according to staff, they follow. At approximately 12pm, staff demonstrated to the LPA a meal (lunch) served to R1, and a list of dietary restrictions to R1, that is posted in the kitchen. A copy of this list of restrictions obtained, and a picture of the meal taken. Based on the information provided during the day's visit, there was insufficient evidence to prove that R1's dietary plan is not being followed. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff is withholding resident's medication:
In regards to the allegation, it was reported that staff has withheld R1's water pill for an entire week. No dates specified when this incident occurred. Interview with a third party could not confirm or specify any dates if this medication was not given as prescribed. Interview with R1 could not confirm the time and day of when their medicine wasn't given to them as prescribed. LPA reviewed R1's medication records for October and November 2023, and did not observe any discrepancies. Copies of these records were obtained. Interviews with two of two residents deny the allegation, stating they've been getting their medications as prescribed. No complaints or concerns raised by these residents. Based on the information obtained there was insufficient evidence to prove that R1's medications were withheld. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff is not providing utensils when serving meals to a resident in care:
In regards to the allegation it was alleged that R1 was served meals without utensils. Interviews with staff deny the allegation. Interview with R1 revealed that this had occurred once as far that they can recall, but couldn't recall when, and has not happened since. Interviews with two of two residents also deny the allegation. These residents stated they are provided and satisfied with a complete meal, and confirm utensils are included when meals are served. At approximately 12:00pm, LPA inspected the food service and observed utensils provided on the trays when meals were being served for the day. A picture was taken. Based on the information obtained, there was insufficient evidence to prove utensils not provided when meals are served to the residents. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

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