247200745-7-13-2022-24-AS-MHON-CJ2N3W-20220907100701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247200745
Report Date: 07/13/2022
Date Signed: 07/13/2022 04:13:58 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2022 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220614114352

FACILITY NAME:	NEW BETHANY		FACILITY NUMBER:	247200745
ADMINISTRATOR:	FONSECA, JULIA		FACILITY TYPE:	740
ADDRESS:	1441 BERKELEY DRIVE		TELEPHONE:	(209) 827-8933
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	76	CENSUS: 42	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	12:38 PM
MET WITH:	Lucinda Fonseca - Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff do not answer the residents alerts timely

INVESTIGATION FINDINGS:

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On 7/13/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint inspection and deliver complaint finding on the above allegation. LPA met with Administrator Lucinda Fonseca and stated purpose of visit.

During the course of the investigation, the Department conducted interviews and toured the facility.
Administrator stated that call buttons are responded to within four minutes. Administrator and LPA observed a sample of residents' call buttons in which were not responded to in a timely manner upon activation.

Based on observation and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2022 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220614114352

FACILITY NAME:	NEW BETHANY		FACILITY NUMBER:	247200745
ADMINISTRATOR:	FONSECA, JULIA		FACILITY TYPE:	740
ADDRESS:	1441 BERKELEY DRIVE		TELEPHONE:	(209) 827-8933
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	76	CENSUS: 42	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	12:38 PM
MET WITH:	Lucinda Fonseca - Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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8
9

Staff is stealing from a resident while in care
Staff made a duplicate key to a resident's personal cabinet
Staff do not provide appropriate care and supervision to the residents

INVESTIGATION FINDINGS:

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2
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5
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On 7/13/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint inspection and deliver complaint findings on the above allegations. LPA met with Administrator Lucinda Fonseca and stated purpose of visit.

During the course of the investigation, the Department conducted interviews, toured the facility, and reviewed records.There was insufficient evidence to prove or disprove that staff were stealing from resident while in care and staff made a duplicate key to resident’s personal cabinet.
Records were review and interviews were conduct facility have adequate staffing. The facility has active flyers advertising available positions.

Based on records reviewed, observations, and interviews which were conducted, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Exit interview conducted. A copy of this report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20220614114352

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: NEW BETHANY	FACILITY NUMBER: 247200745
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2022 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	Personnel Requirements – General All personnel shall be given on the job training…This training and/or related experience shall provide knowledge of and skill…by safe and effective job performance, Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met:	1 2 3 4 5 6 7	Administrator will have in-service training for staff regarding answering residents alert calls in a timely matter.
	8 9 10 11 12 13 14	Based on observation, at 1: 56 p.m and 2:32 pm., Licensing Program Analyst and Administrator observed residents’ call buttons not being responded by staff in a timely matter upon activation which poses a potential health and safety and personal rights risk to the person in care.	8 9 10 11 12 13 14	Documents of staff in-service training and rooster of attendance shall be submitted to CCL by due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

LIC9099 (FAS) - (06/04)

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