306003898-2-2-2022-22-AS-MVAO-CBNS8J-20220215123913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003898
Report Date: 02/02/2022
Date Signed: 02/02/2022 11:15:28 AM

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
01/06/2022 and conducted by Evaluator Albert Marin

COMPLAINT CONTROL NUMBER: 22-AS-20220106183033

FACILITY NAME:	VIA TERCERO HOMES		FACILITY NUMBER:	306003898
ADMINISTRATOR:	ALEXANDER D. GABAT		FACILITY TYPE:	740
ADDRESS:	22645 VIA TERCERO		TELEPHONE:	(949) 305-7357
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 0	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator Alexander Gabat		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff is not providing resident with meals or food.
Facility staff is coughing on food and not wearing a mask.
Facility failed to follow reporting requirements.
Facility staff are violating resident rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the findings for the investigation completed on the complaint filed on January 6, 2022 against this facility. LPA met with Administrator (AD) Alexander Gabat; and stated the purpose of the visit.

On the allegation that facility staff is not providing resident with meals or food, the following are the findings. On January 7, 2022, LPA Marin conducted an unannounced physical visit in the facility. LPA observed that Resident 1 was agitated and heard R1’s voice from the main entrance with doors shut. R1 spoke of having a meal. Staff 1 brought in three stacks of pancake with syrup but R1 refused; and continued pacing inside room. After LPA spoke to R1, and R1 requested oatmeal with almond milk, and slice of cantaloupe and blueberries, which Staff 1 immediate provided. LPA further observed that the facility kitchen countertops were lined up with cereals and other food products often requested by R1. The facility refrigerator and freezer weere fully stocked with perishable goods. LPA observed that the two other residents in care were served with good portions of carbohydrates, protein, and vegetables for lunch service. Based on file review on site, AD Gabat recorded meals served to R1. Thus, the allegation that staff is not providing meals or food is UNFOUNDED.
(Page 1/2)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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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Control Number 22-AS-20220106183033

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: VIA TERCERO HOMES	FACILITY NUMBER: 306003898
	VISIT DATE: 02/02/2022

NARRATIVE

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On allegation that facility staff is coughing on food and not wearing a mask, the following are the findings. On January 7, 2022, LPA Marin conducted an unannounced physical visit in the facility. During the initial encounter with the Administrator and staff member, LPA observed that both were wearing surgical masks at all times. During the entire visit, LPA did not observe either AD and staff to be coughing. On January 13, 2022, the facility conducted Coronavirus 2019 (COVID 19) testing; and all came back negative including R1. Thus, the allegation that staff is coughing on food and not wearing mask is unfounded.

On allegation that facility failed to follow reporting requirements, the following are the findings. AD stated and supported by written documents that on January 5, 2022, AD Gabat called Community Care Licensing Division (CCLD) to report on a COVID 19 positive case. AD received an email from CCLD requesting for information on the positive case. During the January 7, 2022 unannounced visit, LPA observed AD Gabat on the phone with Orange County Public Health and received directions for mass testing. Thus, the allegation that facility failed to follow reporting requirement is unfounded.

On allegation that facility staff are violating resident’s rights, the following are the findings. During the January 7, 2022 unannounced visit, Resident was agitated and spoke to staff members in a loud manner. R1 stated Staff 1 was deaf. When LPA interviewed S1 regarding the hearing deficits, Staff denied and responded to questions asked by the LPA promptly and without any difficulty even with low modulated voice. AD attended to the queries of R1 with calm voice even R1 was highly agitated. Thus the allegation that facility staff are violating resident’s rights is unfounded.

This agency has investigated the complaint. We have found that the above allegations were unfounded, meaning that the allegations were false, could not have happened and/or are without reasonable bases. We have therefore dismissed the complaint.

LPA Marin conducted an exit interview with AD Gabat and copy of this report was left in the facility.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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