198603707-6-6-2025-28-AS-MGFS-DHXNJ8-20250624102955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603707
Report Date: 06/06/2025
Date Signed: 06/06/2025 05:03:49 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
06/04/2025 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250604132711

FACILITY NAME:	AMALIA HOME - OLYMPIC		FACILITY NUMBER:	198603707
ADMINISTRATOR:	JOURDAN SANVICTORES		FACILITY TYPE:	735
ADDRESS:	8526 OLYMPIC BLVD.		TELEPHONE:	(562) 805-5615
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	4	CENSUS: 3	DATE:	06/06/2025
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Jordan Sanvictores, Administrator		TIME COMPLETED:	05:03 PM

ALLEGATION(S):

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Staff did not provide adequate meals to client in care
Staff mismanaged client's medication

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Alberto Lopez and Elena Mallett made an initial 10 day complaint visit to investigate the above allegations. LPA met with Licensee Administrator Jourdan Sanvictores and discussed the purpose of the visit.

The investigation consisted of LPAs taking a tour of facility rooms, common areas, kitchen, food supply, obtaining and reviewing food menu, C1 hourly log for 06/02/2025 and 06/03/2025, medication list for C1, Annual facility Repot for C1 dated 03/01/2025, two (2) most recent incident reports for C1 for medication refusal, and interviewed Four (4) staff (S#1-S#4), one witness (W#1) and two (2) clients (C#1-C#2). One (1) client was not able to answer questions at the time due to language barrier. The investigation revealed regarding allegation staff did not provide adequate meals to client in care. It is alleged that facility did not provide C1 dinner that was on menu on 06/03/25 and instead provided C1 with a plain tilapia against C1 wishes.

(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: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

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-20250604132711

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: AMALIA HOME - OLYMPIC	FACILITY NUMBER: 198603707
	VISIT DATE: 06/06/2025

NARRATIVE

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(continued on 9099C)

LPAs interviewed three (4) staff and two (2) of four (4) staff stated that C1 asked for tilapia. One staff (S4) was not working and unable to answer the question. S2 stated that each client has option to request any item for mealtimes and facility will honor it if possible.

On 06/03/2025, facility had tortellini on the menu for dinner, and according to S2, S2 stated that C1 asked for tilapia in the morning after S2 explained that tortellini ingredients option was not beneficial to C1 due to upset stomach C1 had. C1 stated C1 observed fish on the counter and asked S2 how long it had been on the counter, C1 stated C1 was afraid that fish was bad due to being on the counter for too long and refused to eat it and instead asked for the tortellini. S2 stated that is not correct. fish was thawed out in refrigerator. S3 stated S3 thinks that C1 ate the some of the fish but not sure. C2 stated C2 is not aware of the incident. There are no witnesses to corroborate the allegation of what occurred regarding the incident. All Staff denied giving C1 spicy soup and stated they threw away the spicy packet. There is insufficient evidence to substantiate the allegation.

Allegation: Staff mismanaged client's medication. It is alleged that C1 had stomach pain, and that facility did not provide C1 with Tylenol.

LPA interviewed four (4) staff, and three (3) of four (4) staff denied the allegation. Three (3) of four (4) staff stated they do not have a doctors order for Tylenol for C1 and cannot provide it to the client. S2 stated that C1 never asked for Tylenol, it was W1 who asked to give tylenol to C1.

There is no evidence to support this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

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