331881415-2-28-2024-18-AS-JDHS-D2WU5K-20240229141652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881415
Report Date: 02/28/2024
Date Signed: 02/28/2024 03:53:53 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2024 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20240103104304

FACILITY NAME:	ANGELICA'S HOME, INC.		FACILITY NUMBER:	331881415
ADMINISTRATOR:	OOSTING, ANGELICA		FACILITY TYPE:	740
ADDRESS:	31916 CORTE POSITAS		TELEPHONE:	(321) 432-8883
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92592
CAPACITY:	6	CENSUS: 5	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee, Angelica Oosting		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff are not assisting resident with bathing
Facility staff are not assisting resident with personal care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings regarding the allegations listed above. LPA met with Licensee/Administrator, Angelica Oosting and explained the purpose of the visit and the elements of the allegation. LPA Banrasavong conducted the investigation which consisted of observations, interviews with staff members and residents, and record review.
On 01/03/2020, Community Care Licensing (CCL) received a complaint that alleged staff are not assisting resident with personal care and staff are not assisting resident with bathing. In regards to the allegation of facility staff not assisting resident with personal care, information obtained from an interview with Resident 1 (R1) stated they inquired about applying for In Home Supportive Services and the Assisted Living Waiver Program. R1 stated R1 is currently residing at the facility but stated that the facility may be relocating and wanted to see what other programs can assist with R1's needs.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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 18-AS-20240103104304

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGELICA'S HOME, INC.	FACILITY NUMBER: 331881415
	VISIT DATE: 02/28/2024

NARRATIVE

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R1 stated that there are no issues with staff assisting resident with personal care. R1 stated that all their needs are met at the facility such as assistance with medication, grooming, prepping food, laundry, cleaning, and specifically bathing. LPA interviewed the staff members at the facility, who indicted that there were no issues with assisting the residents with personal care. In regards to facility staff bathing residents, staff members indicated that do assist residents with bathing and they chart when residents refuse showers. LPA was able to verify and randomly pull dates from the time period of R1's residency at the facility to confirm this information. LPA reviewed the months of October, December of 2023 and January of 2024. The information obtained from additional interviews with residents corroborated the information.

Based on LPA's observation, interview conducted, and record reviews, the preponderance of evidence shows that the allegations that facility staff are not assisting resident with personal care and bathing services are unfounded. The Department has found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of the report was provided to the Licensee, Angelica Oosting.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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