<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600216
Report Date: 06/12/2024
Date Signed: 06/12/2024 05:13:46 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240605142503
FACILITY NAME:STRATA BELLA HOMEFACILITY NUMBER:
198600216
ADMINISTRATOR:BELLOSILLO, JOHNETTEFACILITY TYPE:
735
ADDRESS:23217 HUBER AVENUETELEPHONE:
(310) 534-8453
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:4CENSUS: 4DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Krystal Del la CruzTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is in disrepair.
Staff are not adequately supervising residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/12/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Designee Administrator Krystal Del la Cruz and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA toured the physical plant, reviewed records, and interviewed (4) four staff members which included the Designee and (3) three Caregivers.

Continue to LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 4
Control Number 11-AS-20240605142503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: STRATA BELLA HOME
FACILITY NUMBER: 198600216
VISIT DATE: 06/12/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation(s):
Facility is in disrepair.

The investigation revealed the following: Regarding the allegation "Facility is in disrepair,” it is being alleged that the facility is unkempt on the exterior. LPA Cloyd observed the lattice to be in disrepair and discussed the issue with Caregiver #1. Interview indicated that the lattice had been in disrepair for a couple of months. Caregiver #1 repaired the lattice prior to LPA’s departure. Regarding the allegation “Facility is in disrepair,” based on observation, the preponderance of evidence has been met therefore the allegation is Substantiated.
Deficiencies were issued.

An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed and left with the Designee Administrator.


Allegation(s):
Staff are not adequately supervising residents in care.


The investigation revealed the following: Regarding the allegation "Staff are not adequately supervising residents in care,” it is being alleged that the facility has a history of residents escaping – sometimes without clothes. It is being alleged that clients throw items over neighbor’s fence. Record review reveals that Client #1 has thrown clothes over neighbor's fence at least five times from June 1, 2024 – June 12, 2024. Interviews conducted indicated the Client #1 has thrown items over the fence. Interviews conducted indicated that two staff works in the day/afternoon and one staff works at night. Regarding the allegation “Staff are not adequately supervising residents in care,” based on record review and interviews, the preponderance of evidence has been met therefore the allegation is Substantiated.

Deficiencies were issued.

An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights was reviewed and left with the Designee Administrator Krystal Del la Cruz.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240605142503

FACILITY NAME:STRATA BELLA HOMEFACILITY NUMBER:
198600216
ADMINISTRATOR:BELLOSILLO, JOHNETTEFACILITY TYPE:
735
ADDRESS:23217 HUBER AVENUETELEPHONE:
(310) 534-8453
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:4CENSUS: 4DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Krystal Del la CruzTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is unsanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/12/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Designee Administrator Krystal Del la Cruz and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA toured the physical plant, reviewed records, and interviewed (4) four staff members which included the Designee and (3) three Caregivers. The investigation revealed the following: Regarding the allegation "Facility is unsanitary,” LPA Cloyd observed the exterior and interior to be sanitary. Interviews indicated that the facility is maintained and kept clean. Regarding the allegation “Facility is unsanitary,” based on observation and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was reviewed and left with the Designee Administrator Krystal Del la Cruz.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240605142503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: STRATA BELLA HOME
FACILITY NUMBER: 198600216
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2024
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
(a) The facility shall be... in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by:
1
2
3
4
5
6
7
Caregiver #1 repaired the lattice prior to LPA's departure. The Licensee will ensure that future repairs are resolved in a timely manner.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential safety risk to persons in care. LPA observed a fence lattice in disrepair and interview indicated that the lattice has been in disrepair for a couple of months.
8
9
10
11
12
13
14
Type B
06/27/2024
Section Cited
CCR
87468.2(a)(4)
1
2
3
4
5
6
7
Residents... shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by:
1
2
3
4
5
6
7
The Licensee will develop a plan of correction and email regina.cloyd@dss.ca.gov by the POC due date.
8
9
10
11
12
13
14
Based on record review and interviews, staff is not adequately supervising Client #1 which poses/posed a potential health, safety, and/or personal right risk to persons in care. Client #1 has thrown clothes and items over the neighbor's fence. Two staff work in the day and one staff at night.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4