306006367-5-7-2024-22-AS-MVAO-D5KTEZ-20240524144045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006367
Report Date: 05/07/2024
Date Signed: 05/07/2024 04:00:32 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
05/02/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240502150109

FACILITY NAME:	BLISS CARE HOME		FACILITY NUMBER:	306006367
ADMINISTRATOR:	NANDWANI, NIDHI		FACILITY TYPE:	740
ADDRESS:	2609 EAST SANTA YSABEL AVENUE		TELEPHONE:	(909) 964-6720
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	6	CENSUS: 4	DATE:	05/07/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nidhi Nandwani		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure resident is spoken to in an appropriate manner
Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and RoseMarie Ruppert for the purpose of investigating the above-mentioned complaint allegations. LPAs met with Administrator (AD) Nidhi Nandwani and explained the reason for today’s inspection.

The investigation into the allegations that staff do not ensure resident is spoken to in an appropriate manner and staff handled resident in a rough manner revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, and resident files.

CONTINUED

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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-20240502150109

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: BLISS CARE HOME	FACILITY NUMBER: 306006367
	VISIT DATE: 05/07/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that staff do not ensure resident is spoken to in an appropriate manner: it was alleged that residents were told they could no longer remain at the facility if they continue to be disrespectful to staff and that residents get yelled for requesting assistance. LPAs interviewed four out of four residents and did not obtain information corroborating this allegation. LPAs interviewed two staff and did not obtain information corroborating this allegation. LPAs interviewed AD who denied the allegation. The information obtained did not corroborate the allegation.

Regarding the allegation that staff handled resident in a rough manner: it was alleged that residents are being changed aggressively. LPAs interviewed four out of four residents and did not obtain information corroborating this allegation. LPAs interviewed two staff and did not obtain information corroborating this allegation. LPAs interviewed AD who denied the allegation. 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 allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegation are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2