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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005891
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:42:40 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, 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
10/21/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241021164029
FACILITY NAME:NANTUCKET HOMEFACILITY NUMBER:
306005891
ADMINISTRATOR:CANDIAS, JACOBFACILITY TYPE:
737
ADDRESS:1051 NANTUCKET ST.TELEPHONE:
(562) 267-0102
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:3CENSUS: 2DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:George AliimatafitafiTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility did not ensure that the food supply and storage requirements are met
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) George Aliimatafitafi, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that the facility did not ensure that the food supply and storage requirements are met revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, Program Manager (PM) Pua Tata, clients, and staff, and obtained and reviewed copies of the client roster, staff roster, an email dated October 23, 2024, regarding AD’s purchasing card, the facility’s menus for the past year, the facility’s monthly budget, and the facility’s grocery bills for 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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 2
Control Number 22-AS-20241021164029
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: NANTUCKET HOME
FACILITY NUMBER: 306005891
VISIT DATE: 10/24/2024
NARRATIVE
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It was alleged that the facility’s grocery budget was recently limited to $400 per month, which leaves the facility without food and basic necessities halfway through the week. LPA inspected the facility, conducted health and safety checks on the clients, and observed no health and safety issues. LPA inspected the facility’s food supply and observed the facility has a two-day supply of perishables and a seven-day supply of non-perishable food is available as required, expiration dates were marked and there were no expired foods, and the facility has sufficient supplies of soap, toilet paper, and paper towels. LPA interviewed two clients and four staff and did not obtain information corroborating the allegation, but did obtain information that the facility ran out of specific food items, such as cereal and tortillas, and that the menu was not followed due to lack of specific ingredients. Per interviews of two clients and four staff, both clients received all of their meals and had no complaints regarding the food at the facility. LPA interviewed AD and PM who denied the allegation. Per AD and PM, due to recent staffing changes, the process for purchasing groceries changed for approximately the last two months because AD did not have a purchasing card to purchase groceries, but the issue has now been resolved. LPA reviewed an email dated October 23, 2024, regarding AD’s purchasing card which corroborated that the issue with AD’s purchasing card has now been resolved. LPA reviewed the facility’s menus for the past year and did not obtain information corroborating the allegation. AD and PM denied that the grocery budget has changed and stated that the budget is created by the Regional Center but the facility will spend more than the budget if necessary to ensure clients are eating well. LPA reviewed the facility’s monthly budget and the facility’s grocery bills for 2024 which show the facility is following the grocery budget and that the facility’s spending on groceries has been consistent. The information obtained did not corroborate the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2