197610193-2-13-2024-31-AS-MVAO-D2NVF8-20240221152329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610193
Report Date: 02/13/2024
Date Signed: 02/13/2024 11:27:09 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/07/2024 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240207143335

FACILITY NAME:	A HOME FOR MOM & DAD		FACILITY NUMBER:	197610193
ADMINISTRATOR:	APOLINARIO, EMMA L.		FACILITY TYPE:	740
ADDRESS:	44856 33RD STREET W		TELEPHONE:	(661) 418-0016
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 3	DATE:	02/13/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Emma Apolinario		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff did not properly discard all contaminated or spoiled food.

INVESTIGATION FINDINGS:

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On 02/13/2024 Licensing Program Analyst (LPA) Evelin Rios, conducted a unannounced complaint investigation for the allegation listed above. LPA Rios was greeted by staff #1 (S1) who granted access. LPA Rios met with the administrator Emma Apolinario and administrator assistant Amante Apolinario and explained the purpose of the visit. Entrance interviews conducted.

LPA toured the facility at approximately 9:40 a.m. observing food and drinks kept in two (2) refrigerator located in the kitchen and a deep freezer in the hallway. At approximately 10:00 a.m. LPA interviewed three (3) out of three (3) residents. At approximately 10:15 a.m. LPA reviewed and obtained the following documents; resident roster, and sample menus. At approximately 10:25 a.m. LPA interviewed S1.

Allegation: Facility staff did not properly discard all contaminated or spoiled food. It was alleged the facility is serving milk past expiration date once it is thawed. To investigate the allegation LPA observed six (6) milks with different serving sizes in the refrigerator. One (1) of which was a milk substitute. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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-20240207143335

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A HOME FOR MOM & DAD	FACILITY NUMBER: 197610193
	VISIT DATE: 02/13/2024

NARRATIVE

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LPA did not observe any milk in the freezers. LPA observed Five (5) out of the six (6) milks where not past "BEST BY" date. One (1) milk had a "BEST BY FEB 12" date. According to the administrator the milk can be served up to three (3) days past expiration date and then it is thrown out. LPA checked the milk's smell, color and consistency. LPA did not observe it to be spoiled. According to administrators and staff they freeze milk before expiration date and when they need to replenish or replace milk they take it out of the freezer, thaw it in the refrigerator and serve it to residents for approximately one (1) week after thawing. According to administrators they have never served spoiled milk and will throw it away if it is spoiled. LPA noted the milk has a "best by date" and not an "expiration date". Interview with resident #1 (R1) who was able to answer LPA questions, stated they have never been served spoiled milk.

Based on LPA's observations and interviews, the allegation, facility staff did not properly discard all contaminated or spoiled food is Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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