198602253-8-26-2021-31-AS-NMAN-C76T9B-20210924143140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602253
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:58:51 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
08/19/2021 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20210819124750

FACILITY NAME:	BELLA VISTA AT LINCOLN		FACILITY NUMBER:	198602253
ADMINISTRATOR:	HAMILTON, MARK		FACILITY TYPE:	735
ADDRESS:	2612 N LINCOLN AVE		TELEPHONE:	(626) 794-4103
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	50	CENSUS:	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Amada Lopez, Supervisor		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility illegally evicting resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint visit to the facility. LPA met with Amada Lopez, Supervisor. The purpose of the visit was discussed.

It was reported that facility is illegally evicting resident. On 08/26/2021 at 10:14am, LPA spoke to facility staff and they denied that they are trying to evict Resident #1 (R1). Interviews revealed that a medical doctor came to the facility on 08/16/2021 and told staff to send R1 to the hospital for wound treatment. Between 11:00am and 12pm records were reviewed. On 08/17/2021 R1 was sent to the hospital. On 08/21/2021, R1 left the hospital without being discharged and returned to the facility. R1 is currently residing at the facility. Facility will have a doctor reappraise R1 to determine if the facility is the appropriate setting.

Based on interview and record review the above noted allegation is UNSUBSTANTIATED at this moment.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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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