198600775-8-10-2023-28-AS-FFIS-CY436G-20231130165819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600775
Report Date: 08/10/2023
Date Signed: 08/10/2023 02:47:38 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, 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
08/01/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230801141237

FACILITY NAME:	STRATA BELLA (NORWALK) CORPORATION		FACILITY NUMBER:	198600775
ADMINISTRATOR:	RUDY DEOCAMPO		FACILITY TYPE:	735
ADDRESS:	13213 FLALLON AVENUE		TELEPHONE:	(562) 864-9803
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	4	CENSUS: 3	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:			TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff did not ensure that resident consumed a sufficient amount of food.
Staff forced a resident to throw another residents food away.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon arrived at the facility at 9:00pm.Upon arriving LPA knocked on the door and rang the door bell and no one answered. LPA then contacted facility at (562) 864-9803 and left a voice message. LPA called the facility Administrator Johnette Bellosillo and LPA explained the purpose of todays visit. Bellosillo stated she will arrive at the facility as soon as she can. At 9:20am Staff #1 greeted LPA Calderon and LPA explained purpose of todays visit. At 9:35am Administrator Johnette Bellosillo arrived at the facility to assist.

Today's visit consisted of LPA interviewing Administrator and Staff #1(S1) and Staff #5(S5) in person. LPA telephonically interview Staff #2 and #3 (S2& S3) and attempt to interview Staff #4(S4). LPA attempt to interview Harbor Regional Service Coordinator (SC) and later during visit received a call from Service Coordinator and SC was interviewed. LPA interview Client #1 (C1), Client #2 (C2) and Client #3 (C3). LPA collected Client #1-#3 (C1-C3) Physician's Report and Individualized Service Plan (IPP). C1 Physician Care Communication report and facility communication log. LPA collected via email Client and Staff Roster and Food Menu. LPA observed food supply in the kitchen and 2 pantry rooms. LPA observed lunch time (Continuation on 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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 28-AS-20230801141237

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STRATA BELLA (NORWALK) CORPORATION	FACILITY NUMBER: 198600775
	VISIT DATE: 08/10/2023

NARRATIVE

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Based on allegation: Staff did not ensure that resident consumed a sufficient amount of food. LPA Calderon interviewed Administrator and four staff S1-S3 and S5, all staff denied the above allegation stating clients are provided with sufficient amount of food, facility has sufficient food in place, and clients are able to have alternatives and eat what they want. Interview with 2 out of 3 clients revealed, C1 and C2 stated they and other clients are provided with sufficient amount of food and facility have plenty of food for clients in care. C3 was unable to contribute to the allegation listed above as C3 is unable to communicate due to cognitive abilities. LPA observed the kitchen and 2 pantry rooms having more than sufficient perishable and non-perishable food items for clients in care. LPA observed lunch and all clients received a meal and had sufficient food amount. LPA observed a food menu created by a Registered Dietitian and observed C1 asking for alternative food options and was provided with food requested. Based on observation, record review and interviews, there is insufficient evidence to support this allegation.

Based on allegation: Staff forced a resident to throw another residents food away. LPA interview Administrator and four staff, S1-S3 and S5, all staff denied the above allegation stating no client are forced to do anything they don't want too and staff are not forcing clients to throw other clients food items away. Interviews with clients revealed that C1 stated client's and self are not forced to throw other residents food items away. C1 stated when staff ask C1 to do something C1 does it as a detective and is their self-choice to do a task like throwing a residents food away to help a client or a staff. C2 and C3 were unable to collaborate with the above allegation due to cognitive abilities. LPA observed meal time, client's were self fed with staff monitoring and providing assistance when required. Based on observation, record review and interviews, there is insufficient evidence to support this allegation.

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, therefore the allegations are unsubstantiated.

An exit interview was conducted. A copy of this report was provided to Staff #1.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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