198602869-1-26-2023-28-AS-LHIS-CTGPCT-20230706111229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602869
Report Date: 01/26/2023
Date Signed: 01/26/2023 03:18:33 PM

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
01/20/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230120120544

FACILITY NAME:	JJVITACARE1, INC		FACILITY NUMBER:	198602869
ADMINISTRATOR:	VITANGCOL, MYRABEL		FACILITY TYPE:	735
ADDRESS:	21321 FOUNTAIN SPRINGS ROAD		TELEPHONE:	(909) 641-7109
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 6	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Maria Concepcion DSP		TIME COMPLETED:	03:26 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to treat client with dignity and respect
Staff failed to provide privacy to client
Staff confined client to her room
Client's personal rights are being violated

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Alberto Lopez conducted an unannounced initial complaint visit and met with DSP Maria Concepcion and spoke with Administrator Florentino Vtangcol via phone. The purpose of the visit was discussed. Administrator stated he was unable to come to facility and authorized DSP Maria Concepcion to sign report.
The investigation consisted of interviews with Clients 1-4 (C1 - C4), staff 1-5 (S1-S5), Witness #1 (W1) and review of resident’s files.

Regarding allegation: Staff failed to treat resident with dignity and respect. It is alleged that staff do not treat clients with dignity and respect. 3 of four residents denied the allegation. 5 of 5 staff denied the allegation and W1 did not witness allegation ever.

(Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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-20230120120544

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: JJVITACARE1, INC	FACILITY NUMBER: 198602869
	VISIT DATE: 01/26/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding allegation: Staff failed to provide privacy to resident. It is alleged that staff listen in to client’s phone calls. The house phone is in the common area of the kitchen and when R1 uses the phone, R1 puts it on speaker phone with high volume and anyone around the common area can hear. 6 of 6 staff denied that they listen in on phone call and 3 of 4 residents denied the allegation. W1 has never witnessed this allegation.

Regarding allegation: Staff confined client to her room. It is alleged that staff will send R1 to her room. 2 of 4 residents could not collaborate the allegation. W1 stated W1 had never witness this. 6 of 6 staff denied the allegation.

Regarding allegation: Residents’ personal rights are being violated. It is alleged that client is not allowed use of personal tablet. R1 denied owning a tablet and 4 of 4 residents could not collaborate the allegation. 6 of 6 staff interviewed denied the allegation and 6 of 6 staff stated they never violate client’s personal rights and have a big poster on the wall to remind them of client’s personal rights.

Based on statements and interviews conducted with staff, clients, witness, and review of client file, there was not enough supportive evidence to concur with the reported allegations.

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 held, hard copy and appeal rights was provided to DSP Maria Concepcion.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2