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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602531
Report Date: 06/20/2024
Date Signed: 06/20/2024 10:35:33 AM

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
06/07/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240607082550
FACILITY NAME:CALVITACARE1 CORPFACILITY NUMBER:
198602531
ADMINISTRATOR:MYRABEL VITANGCOLFACILITY TYPE:
735
ADDRESS:3037 EAST MERRYGROVE STREETTELEPHONE:
(626) 612-7318
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY:4CENSUS: 4DATE:
06/20/2024
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Divina Sanchez, StaffTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Staff yelled at resident.
Staff withheld food from resident.
Staff did not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation visit regarding the above allegations. The purpose of the visit was explained to staff Divina Sanchez.

The investigation consisted of: On 6/10/24, a physical plant tour was completed. Staff (S1-S4) and residents (R1-R2) were interviewed. Resident (R1's) Identification/Emergency Information, IPP, and Care Notes were obtained. On 6/15/24, LIC 500 Personnel Report and resident roster were emailed. During today's visit, LPA toured the facility and interviewed telephonically residents (R3 & R4) and family (F1).

.***Narrative continues next page.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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 2
Control Number 28-AS-20240607082550
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: CALVITACARE1 CORP
FACILITY NUMBER: 198602531
VISIT DATE: 06/20/2024
NARRATIVE
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Allegation: Staff yelled at resident. It is alleged that staff (S1)/supervisor has been overheard yelling and speaking to resident (R1) in a strong tone of voice when the resident is talking on the phone. Staff and resident interviews were conducted, of which all denied the allegation. Staff (S1) stated that they do not yell at resident (R1) or other residents, but sometimes they speak to the residents in a firm voice when they are not listening. All staff acknowledged that staff (S1) has a natural louder tone of voice. Resident (R1) stated that staff (S1) speaks loudly to the resident and all other residents as well, but staff (S1) does not yell. Administrator stated that staff speak with an accent, but do not yell at residents, and none of the residents have ever complained. Family (F1) stated that one time they were talking on the phone with R1, and they overheard a staff member address the resident in a verbally aggressive tone. Based on interviews conducted, there is insufficient evidence to support the allegation.

Allegation: Staff withheld food from resident. It is alleged that on May 27, 2024, staff did not give resident (R1) breakfast because the resident woke up late. According to information obtained via staff and resident interviews, the findings indicate that on May 27, 2024, resident (R1) got up at 6:30 AM, took their AM medications, ate breakfast and 30 minutes later the resident took a nap. When it was lunch time staff tried waking the resident up at 12 PM for lunch meal, but the resident was sleepy and continued napping. Based on record review, resident (R1) is on a low carbohydrate and low sweets diet that staff follow. The resident is served healthier foods. Resident (R1) stated that on May 27, 2024, staff did not give the resident lunch because the resident was sleeping. R1 stated staff feed everyone well and they are allowed to get food at other times. The resident confirmed they are following a physician ordered healthy diet and have lost weight as a result. All 4 staff, all 4 residents, and family denied the allegation.

Allegation: Staff did not treat resident with dignity and respect. According to information obtained, resident (R1) is not treated well by most staff, with the exception of one (1) staff. All four (4) staff interviewed denied the allegation, and stated that resident (R1) and all other residents are always treated in a respectful manner and are afforded privacy. Four (4) residents were interviewed, of which all, including resident (R1) stated that staff treat all residents in a dignified and respectful manner. Resident (R1's) family was interviewed, and they stated they have never seen staff treat residents in a disrespectful manner.

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 conducted with staff Divina Sanchez. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC9099 (FAS) - (06/04)
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