342700429-7-1-2021-25-AS-LMUZ-C4PTE9-20210707143935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700429
Report Date: 07/01/2021
Date Signed: 07/01/2021 02:42:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2021 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20210610115505

FACILITY NAME:	NEW LIFE		FACILITY NUMBER:	342700429
ADMINISTRATOR:	CUSTURA, VLAD		FACILITY TYPE:	740
ADDRESS:	6307 GRANT AVE		TELEPHONE:	(916) 855-5302
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	07/01/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Vlad Custura, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff left residents unattended.
Staff yells at residents.
Staff refused visitations.
Staff shut off heater at night.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete a complaint investigation and deliver findings. . LPA met with Vlad Custura, Administrator, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and confirmed with Licensee there are no positive Covid cases. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask was worn. Additionally, LPA was screened by Administrator upon entering the facility.

During the course of the investigation, LPA interviewed Administrator, Co-Administrator, relative of Administrator who lives at the location, (2) staff, (3) residents, (2) resident representatives. Complaint information received indicates that complaint is being filed from time period 2017- December 2018. Department records document that this facility was licensed on February 1, 2019, as a change in ownership to the previous facility licensed at the same location.

The results of the investigation are as follows:

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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 3

Control Number 25-AS-20210610115505

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: NEW LIFE	FACILITY NUMBER: 342700429
	VISIT DATE: 07/01/2021

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

Allegation: Facility staff left residents unattended. All resident, resident representative and staff interviews indicated that staff has never left residents unattended. One resident representative stated there are typically (2) care staff present when she visits 2-3 times weekly. LPA observed on 6/18/2021 and on 7/1/2021 that there was at least (1) staff and the Administrator present at the facility. Time period of complaint is from 2017- December 2018, before the current Licensee was issued a license at the same facility location.

LPA finds this allegation to be UNFOUNDED- meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff yells at residents. All resident, resident representative and staff interviews concluded that no staff has ever yelled at a resident(s). Residents and their representatives indicated that staff always treats residents with respect. Time period of complaint is from 2017- December 2018, before the current Licensee was issued a license at the same facility location.

LPA finds this allegation to be UNFOUNDED- meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation: Staff refused visitations. All resident interviews indicated that they are allowed visitors at the facility and have never been denied visitation. Interviews with resident representatives revealed that they have never been denied visitation when visiting the facility, even when unannounced. LPA observed a visitor log with multiple completed pages, dating back to 2019 when the facility was licensed. LPA took photos of the visitor book pages for January through March which showed there were regular visitors, sometimes daily, including visits by nurses, physical/occupational therapy and hospice.

LPA finds this allegation to be UNFOUNDED- meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

cont on 9099C(1)..

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 25-AS-20210610115505

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: NEW LIFE	FACILITY NUMBER: 342700429
	VISIT DATE: 07/01/2021

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

Allegation: Staff shut off heater at night. Residents indicated to LPA in interviews that the temperature is always comfortable in the facility. One resident stated that the air-conditioning automatically comes on. Resident representatives indicated they are not aware of an issue with the heater not coming on when needed. Administrator stated "the heater has never had a malfunction and the A/C guy would fix it the same day" if there was an issue. Administrator also stated there are two different heating/cooling units within the house, one for the residents' side of the house and one for the residential side, and both have automatic timers set.

LPA finds this allegation to be UNFOUNDED- meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Based on information provided by the complainant and obtained during the investigation, LPA finds all (4) allegations to be UNFOUNDED- meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

There are no deficiencies being issued on this report and the complaint is being dismissed.

Exit interview. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3