275202056-10-12-2021-26-AS-KHOS-C88J46-20211028064237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202056
Report Date: 10/12/2021
Date Signed: 10/12/2021 12:41:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2020 and conducted by Evaluator Marybeth Donovan

COMPLAINT CONTROL NUMBER: 26-AS-20200728081038

FACILITY NAME:	CIELO VISTA		FACILITY NUMBER:	275202056
ADMINISTRATOR:	MARK CASTILLO		FACILITY TYPE:	735
ADDRESS:	806 ELM AVENUE		TELEPHONE:	(831) 674-2180
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY:	40	CENSUS: 40	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Mark Castillo		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff is not utilizing appropriate sanitation methods.
Staff does not provide adequate meals to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the findings to the above allegations. LPA met with Mark Castillo Administrator.

Between 08/05/2020-10/27/2020 a total of five staff were interviewed. 4 out of 5 staff stated when staff uses an ear thermometer or a touchless thermometer to check the clients’ temperature, the thermometer is cleaned with alcohol wipes after each use and ear probes are changed prior to next usage. 4 out of 5 staff were not aware of a time staff did not utilize sanitization methods. 5th staff member does not provide direct care services to clients.

All staff stated the facility serves 3 meals and 2 snacks. Clients can ask for seconds if food is still available. S1 stated meals portions are reviewed by a dietitian. All staff were not aware of a time staff did not provide adequate meals to the clients.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Marybeth Donovan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 26-AS-20200728081038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: CIELO VISTA	FACILITY NUMBER: 275202056
	VISIT DATE: 10/12/2021

NARRATIVE

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On 09/23/2020 a total of six clients were interviewed. 6 out of 6 clients stated staff sanitizes devices before each usage. All clients stated the meal portions are adequate and the facility serves 3 meals and 2 snacks. All clients stated they can ask for seconds on food if available and can ask for a snack if they miss snack time.

On 10/25/2020 a witness (W1) was interviewed. W1 did not receive any complaints from W1’s client about the facility. W1 was not aware of any equipment used on the clients that were not sanitized before use. W1 stated the facility serves 3 meals and 2 snacks. W1 observed meal portions to be adequate and healthy.

On 08/05/2021 at 12:25pm LPA conducted a tour of the kitchen area, dining room, and medication room via FaceTime. In the medication room, Administrator demonstrated how staff clean the ear thermometer and the touchless thermometer. Ear probes on the thermometer are changed after each use and wiped with alcohol wipe. Touchless thermometer is disinfected and wiped down before each use.

LPA observed a lunch meal service. Clients were served pineapple pork, rice, and mixed vegetables, and for clients who were vegetarian, the chef substituted the protein with tofu. The chef used a measuring spoon to measure out the ounces for each food item and place them in the resident’s bowl. The clients pick up their food at the kitchen door. LPA observed 2 days’ worth of perishables and 7 days’ worth of non-perishables in the refrigerator, freezer, and the pantry.

Daily menu reviewed and it shows that the facility serves breakfast, lunch, and dinner. Meals served consist of grains, fruits, vegetables, protein, and iced tea or lemonade.

Procedures for sanitization of monitoring devices were reviewed and it states that devices used to monitor the clients’ condition are cleaned after each use with disinfectant spray.

This Department has investigated the above allegations, and based on interviews, records review, and observations the Department has determined that the allegations were Unsubstantiated, meaning that although the allegations may have happened or iare valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

This report was reviewed with Mark Castillo Administrator and a copy of this report provided.
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SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: Marybeth Donovan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC9099 (FAS) - (06/04)

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