306001749-12-2-2020-22-AS-SSAS-BW38HA-20201206213137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001749
Report Date: 12/02/2020
Date Signed: 12/02/2020 03:46:30 PM

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
09/04/2020 and conducted by Evaluator Michael Barrett

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200904143529

FACILITY NAME:	ARVILINH HOME CARE		FACILITY NUMBER:	306001749
ADMINISTRATOR:	ARVIN BUMANGLAG		FACILITY TYPE:	740
ADDRESS:	9351 MELBA DRIVE		TELEPHONE:	(714) 643-9077
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS:	DATE:	12/02/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator (AD) Arvin Bumanglag		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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-Facility staff does not feed resident sufficient food amount.
-Facility staff does not meet resident's hygiene needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mike Barrett contacted the facility via telephone for the purpose of presenting the findings of the complaint investigation due to COVID 19 and pre-cautionary measures. LPA Barrett identified himself and discussed the findings with Administrator (AD) Arvin Bumanglag. The following are the findings of the investigation initiated by LPA, Jim August and completed by LPA Barrett, which involved interviews, record review and site observations.

On September 4, 2020, the Department received a complaint alleging that the facility staff does not feed resident sufficient food amount. It was reported that Resident #1 (R1) was not getting enough food. Interviews were conducted with R1, Staff #1 (S1), Staff #2 (S2) and Administrator (AD) regarding the above allegation. During the interviews R1 stated that things were going fine and did not wish to answer any questions. AD and staff attested that R1 was fed 3 meals per day as well as snacks. This agency has investigated this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Continued on page 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael Barrett	TELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

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 22-AS-20200904143529

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: ARVILINH HOME CARE	FACILITY NUMBER: 306001749
	VISIT DATE: 12/02/2020

NARRATIVE

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The Department also received a complaint alleging facility staff are not meeting the resident’s hygiene needs. It was reported that R1 was not being properly bathed. Interviews were conducted with R1, S1, S2 and AD regarding the above allegation. R1 did not wish to answer any questions and stated that things were going fine. AD, S1 and S2 all attested that R1 was getting bathed two (2) to Three (3) times per week and would often refuse baths. Interviews revealed that R1 would often request baths at irregular times but staff would try to accommodate R1 as best they could. This agency has investigated this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

This department has investigated this complaint. No violations are being cited at this time.

An exit interview was conducted with Administrator, Arvin Bumanglag via telephone and a copy of this report was provided to Administrator Bumanglag via email and a read receipt was requested to confirm the delivery of this report.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael Barrett	TELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

LIC9099 (FAS) - (06/04)

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