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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001706
Report Date: 01/20/2023
Date Signed: 01/20/2023 11:25:20 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20230106152218
FACILITY NAME:BEST ELDERLY CARE IFACILITY NUMBER:
306001706
ADMINISTRATOR:MARIANA NITAFACILITY TYPE:
740
ADDRESS:17912 LINCOLN STTELEPHONE:
(714) 639-5885
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:6CENSUS: 5DATE:
01/20/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mariana Nita- Administrator TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility does not allow residents to have visitors.
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver findings. LPA was greeted and granted entry to the facility by Administrator Mariana Nita and discussed the findings for the allegation above.

The department received a complaint on 01/06/2023 and the department made an initial visit on 01/13/2023. During the course of the investigation, the Department interviewed staff, residents and witnesses. In addition, the department obtained copies of resident roster, Infection Control Plan, and visitation sign in sheet. Regarding the allegation the facility does not allow residents to have visitors, the investigation revealed the following:

Per interviews with the Administrator, 3 residents in the facility tested positive for COVID-19 around 12/26/2022. Based on interviews with a witness it was alleged the facility was not going to allow visitors until March 31st 2023. Based on review of the facility visitor log there were multiple visits between 01/09/2023 and 01/13/2023.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
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 5
Control Number 22-AS-20230106152218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEST ELDERLY CARE I
FACILITY NUMBER: 306001706
VISIT DATE: 01/20/2023
NARRATIVE
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Interviews with 6 out of 6 residents indicate their families have not reported any issues with denied visitation. Based on interview with 1 resident's responsible party the facility has never denied visitation.

Therefore based on the preponderance of evidence gathered, interviews conducted, records reviewed and observations made the allegation that facility does not allow residents to have visitors is UNFOUNDED meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20230106152218

FACILITY NAME:BEST ELDERLY CARE IFACILITY NUMBER:
306001706
ADMINISTRATOR:MARIANA NITAFACILITY TYPE:
740
ADDRESS:17912 LINCOLN STTELEPHONE:
(714) 639-5885
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:6CENSUS: 5DATE:
01/20/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mariana Nita- Administrator TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility does not follow the reporting requirements.
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver findings. LPA was greeted and granted entry to the facility by Administrator Mariana Nita and discussed the findings for the allegation above.

The department received a complaint on 01/06/2023 and the department made an initial visit on 01/13/2023. During the course of the investigation, the Department interviewed staff, residents and witnesses. In addition, the department obtained copies of resident roster, Infection Control Plan, and visitation sign in sheet. Regarding the allegation the facility does not follow reporting requirements, the investigation revealed the following:

Per interviews with the Administrator, 3 residents in the facility tested positive for COVID-19 around 12/26/2022.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20230106152218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BEST ELDERLY CARE I
FACILITY NUMBER: 306001706
VISIT DATE: 01/20/2023
NARRATIVE
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 Administrator stated they reported to the California Department of Public Health and did not know based on the review of Provider Information Notices (PIN) that Community Care Licensing Department (CCLD) would not be informed. Based on interviews with 3 out of 3 staff the facility had residents that tested positive for COVID and no report or verbal notification was provided to CCLD or LPA Mendivil.

Therefore based on the preponderance of evidence through interviews the allegation that the facility does not follow reporting requirements is SUBSTANTIATED, meaning the complaint allegation was valid and that a violation has occurred.

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.

An exit interview was conducted and a copy of this report and appeal rights was provided to the Administrator.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230106152218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: BEST ELDERLY CARE I
FACILITY NUMBER: 306001706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2023
Section Cited
CCR
87211(a)(2)
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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...2) Occurrences, such as epidemic outbreaks... which threaten the welfare, safety or health of residents, personnel or visitors,
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Adminstrator agrees to self ceritfy the understanding of the reporting requirements in addition to updating Infection Control Plan's verbiage to incude reporting outbreaks to CCLD and provide proof to LPA by 1/27/23
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...shall be reported within 24 hours either by telephone or facsimile to the licensing agency... This requriement was not met as evidence by the Administrator did not notify CCLD of COVID positive residents.This poses a potential health and safety risk to those in care.
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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: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5