198603003-9-7-2021-28-AS-MVAO-C74MUK-20210922095515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603003
Report Date: 09/07/2021
Date Signed: 09/07/2021 04:15:34 PM

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
08/19/2020 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20200819154019

FACILITY NAME:	ALTA LOMA GARDENS RESIDENTIAL CARE #2		FACILITY NUMBER:	198603003
ADMINISTRATOR:	STARK PLEITEZ, ANA M		FACILITY TYPE:	740
ADDRESS:	1667 WOODBEND DR		TELEPHONE:	(818) 922-5427
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	6	CENSUS: 3	DATE:	09/07/2021
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	Licensee, Margarita Stark		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff left resident in soiled clothing for extended amount of time.
Staff failed to provide adequate food service to residents.
Staff used resident's personal care products on other residents.
Staff failed to destroy previous residents’ centrally stored prescription medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Linda Almaraz and Alberto Lopez conducted a sub-sequent complaint visit to investigate the allegations listed above. LPA's were greeted by Caregiver, Oliver Velasco and explained the reason for today's visit. Later during the visit, Licensee, Margarita Stark arrived at the facility.

The investigation consisted of the following: On 8/28/2020, LPA Almaraz conducted interviews with Administrator, Staff #1, and Residents #1-2. LPA requested copies of: Staff and Resident Roster, facility Food Menu, and files for all (5) residents that were living at the facility at about 12:15PM. The only documents received were rosters and Food Menu at about 2:55PM. LPA was unable to review files because they were never sent. On 9/7/21, LPA's Almaraz and Lopez interviewed new residents at the facility who shall be referred to as #3 and #4, staff #2, and also checked the food supply. Resident #3 is non-verbal and had limited responses.

The investigation revealed the following: (Continued on an LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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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Control Number 28-AS-20200819154019

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: ALTA LOMA GARDENS RESIDENTIAL CARE #2	FACILITY NUMBER: 198603003
	VISIT DATE: 09/07/2021

NARRATIVE

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In regards to allegation, "Staff left resident in soiled clothing for extended amount of time" based on interviews conducted with staff and residents, the residents are changed frequently and have no issues with being changed. Resident #4 indicated the resident can alert staff to be changed and the only issue the resident had was the preference of a female caregiver to change the resident. Staff interviews stated the residents are checked about every 2 hours.

In regards to allegation, "Staff failed to provide adequate food service to residents" interviews conducted with residents revealed they are fed and have no problems with the food. LPA's observed staff preparing lunch and also checked the food supply. LPA's seen no deficiencies or any concerns. Interviews with staff indicated they have plenty of food and the residents get good quality food.

In regards to allegation, "Staff used resident's personal care products on other residents" based on interviews conducted with residents, they do not have to share their personal care items with other residents. LPA Almaraz also verified stock available of personal care items. LPA's also checked each residents room and seen that each resident had their own items. Interviews with staff revealed they have enough personal care items for residents if need be. Staff also indicated they do not use other residents diapers or any other items on another resident.

In regards to allegation, "Staff failed to destroy previous residents’ centrally stored prescription medications" during todays visit, LPA's inspected medication for all current residents at the facility and did not see any medication belonging to previous residents no longer at the facility. Interviews with Licensee, staff #1 and 2, revealed they do not keep medication from other residents if they are no longer living there. When residents move out they take their medication and if the resident expires, they ask hospice to dispose of it.

Based on observation and interviews conducted there was not enough supportive evidence to concur with the reported allegations. 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.

Licensee left the facility during the visit and LPA conducted an exit interview telephonically with her and left a copy of this report with caregiver Oliver.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC9099 (FAS) - (06/04)

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