198602253-10-20-2022-31-AS-RRAZ-CL234U-20221109165543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602253
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:40:01 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
10/11/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20221011110829

FACILITY NAME:	BELLA VISTA AT LINCOLN		FACILITY NUMBER:	198602253
ADMINISTRATOR:	HAMILTON, MARK		FACILITY TYPE:	735
ADDRESS:	2612 N LINCOLN AVE		TELEPHONE:	(626) 798-9118
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	50	CENSUS: 38	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Amada Lopez, Manager		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff do not address resident by chosen name

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Amada Lopez, Manger. The purpose of the visit was discussed.

It was reported that staff do not address resident by chosen name. To investigate this allegation, on 10/20/2022 between 1:45pm and 2:15pm, staff interviews were initiated. Interviews revealed that this is the second time that Resident #1 (R1) has changed their chosen name. Moreover, not all staff were aware that R1 had changed their chosen name again. On 10/19/2022, LPA spoke to R1. R1 indicated that a staff meeting was held, and that now all staff call them by the chosen name. Facility staff confirmed this information.
Based on interviews there is not sufficient information to support this allegation. Therefore, this allegation is deemed UNSUBSTANTIATED at this time.

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: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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