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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600775
Report Date: 10/12/2022
Date Signed: 10/14/2022 08:20:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2022 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220801152041
FACILITY NAME:STRATA BELLA (NORWALK) CORPORATIONFACILITY NUMBER:
198600775
ADMINISTRATOR:RUDY DEOCAMPOFACILITY TYPE:
735
ADDRESS:13213 FLALLON AVENUETELEPHONE:
(562) 864-9803
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:4CENSUS: 3DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Johnette Bellosillo - LicenseeTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility did not respond to resident's medical episode in an appropriate manner
Resident is not being provided adequate food while in care
INVESTIGATION FINDINGS:
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 *This report supersedes the report dated 08/09/22 to include additional information*
Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Johnette Bellosillo (Licensee) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained a copy of the client and staff rosters, copy of C1's physician report and weight record, conducted a tour, and interviewed the Licensee, Staff 1 (S1), and Client 1 – Client 3 (C1-C3).

The investigation revealed the following: regarding the allegation "facility did not respond to resident's medical episode in an appropriate manner", it is alleged that C1 had a seizure and was taken to the hospital. The facility’s home manager was informed and was asked to pick up C1 from the hospital. The home manager responded that she has other responsibilities and too busy with other problems. (CONTINUED TO LIC 9099C)

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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 2
Control Number 28-AS-20220801152041
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775
VISIT DATE: 10/12/2022
NARRATIVE
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Staff interviewed denied the allegation and stated that the house manager was busy with another client, but communicated with the hospital and was able to get C1 transportation to the facility. Clients interviewed were unable to corroborate the allegation. C1 confirmed that the house manager contacted the hospital to get her transportation back to the facility and the house manager was in constant communication with C1 until C1 arrived at the facility. C2 and C3 are non-verbal and were unable to respond to any questions.

Regarding the allegation "resident is not being provided adequate food while in care”, it is alleged that C1 is not being fed and that facility denies alternative meals. Staff interviewed denied the allegation. Staff stated that food is always offered and provided to the clients 3 times a day, and they do have alternative foods. Clients interviewed were unable to corroborate with the allegation. C1 stated they receive 3 meals and 2 snacks a day and are provided with alternative foods when requested. C2 and C3 are non-verbal and were unable to respond to any questions. During the facility tour, 7 days of non-perishable foods and 2 days of fresh perishable foods were observed.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2