342700919-5-31-2024-27-AS-KHOS-D6KNNJ-20240625103650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700919
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:23:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/09/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240409141322

FACILITY NAME:	VITA BELLA ELDERLY CARE		FACILITY NUMBER:	342700919
ADMINISTRATOR:	LABELLA, MARK		FACILITY TYPE:	740
ADDRESS:	4082 73RD STREET		TELEPHONE:	(916) 594-7250
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	10	CENSUS: 7	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Theodore Patterson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff handles resident in a rough manner.
Staff yells at residents in care.
Staff are forcing a resident to sleep early.
Staff inappropriately disciplined residents in care.

INVESTIGATION FINDINGS:

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On 05/31/2024 at 2:00 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with direct caregiver, Theodore Patterson and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 7 residents with 2 facility staff presents. A brief interview with conducted with Theodore. Administrator Mark Labella was not present during today’s visit.

Allegation: Staff handles residents in a rough manner.
It was alleged that staff handles residents in a rough manner. This investigation consisted of observations and interviews with staff, residents, and the two outside agencies. LPA Lee interviewed 3 out of 3 facility staff who denied the allegations and has not witnessed staff handling residents in a rough manner. LPA Lee also interviewed 6 out of 6 residents who also denied the allegation that staff handled residents in a rough manner.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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 3

Control Number 27-AS-20240409141322

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VITA BELLA ELDERLY CARE	FACILITY NUMBER: 342700919
	VISIT DATE: 05/31/2024

NARRATIVE

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Moreover, LPA Lee interviewed a register nurse (RN) who visit the facility regularly and has not witness facility staff handled resident in a rough manner. RN stated that the days that RN is at the facility RN has only witnessed the staff being friendly to residents and puts the residents needs first even when outside agency are present and needs assistant. In addition, interview with the ombudsman, it was learned that ombudsman has no concerns with the facility through observations when the ombudsman’s been at the facility. On 04/16/2024 visit, LPA Lee observed two caregivers assisting two different residents with changing and LPA observed the two staff were gentle and provided direction of what they were doing. Based on the interviews and statements obtained during the investigation process, the allegation has not been corroborated. The allegation that staff handles residents in a rough manner is determined to be unsubstantiated.

Allegation: Staff yells at residents in care.
It was alleged that staff yells at residents in care. This investigation consisted of interviews with staff, residents, and the two outside agencies. LPA Lee interviewed 3 out of 3 facility staff who denied the allegations and stated that they have not witness any facility staff yelling at residents in care. LPA Lee also interviewed 6 out of 6 residents and 5 out of 6 residents denied the allegation that staff yells at residents in care. Moreover, LPA Lee interviewed a register nurse (RN) who visit the facility regularly and has not witness facility staff yelling at residents. RN stated that the days that RN is at the facility RN has only witnessed the staff being friendly to residents and puts the residents needs first even when outside agency are present and needs assistant. In addition, interview with the ombudsman, it was learned that ombudsman has no concerns with the facility through observations when the ombudsman’s been at the facility. Based on the interviews and statements obtained during the investigation process, the allegation has not been corroborated. The allegation that staff yells at resident in care is determined to be unsubstantiated.

Allegation: Staff are forcing a resident to sleep early.
It was alleged that staff are forcing a resident to sleep early. This investigation consisted of interviews with staff, residents, and the two outside agencies. LPA Lee interviewed 3 out of 3 facility staff who denied the allegations and stated that they have not witness any facility staff forcing a resident to sleep early. LPA Lee also interviewed 6 out of 6 residents who also denied the allegation that staff yells at residents in staff are forcing a resident to sleep early.

Continued LIC 9099-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240409141322

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VITA BELLA ELDERLY CARE	FACILITY NUMBER: 342700919
	VISIT DATE: 05/31/2024

NARRATIVE

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Moreover, LPA Lee interviewed a register nurse (RN) who visit the facility regularly and has not witness facility staff yelling at residents. RN stated that the days that RN is at the facility RN has only witnessed the staff being friendly to residents and puts the residents needs first even when outside agency are present and needs assistant. In addition, interview with the ombudsman, it was learned that ombudsman has no concerns with the facility through observations when the ombudsman’s been at the facility. Based on the interviews and statements obtained during the investigation process, the allegation has not been corroborated. The allegation that staff are forcing a resident to sleep early is determined to be unsubstantiated.

Allegation: Staff inappropriately disciplined residents in care.
It was alleged that staff inappropriately disciplined residents in care. This investigation consisted of interviews with staff, residents, and the two outside agencies. LPA Lee interviewed 3 out of 3 facility staff who denied the allegation and stated that they have not witness facility staff inappropriately disciplining residents in care. LPA Lee also interviewed 6 out of 6 residents who also denied the allegation that staff yells at residents in staff are forcing a resident to sleep early. Moreover, LPA Lee interviewed a register nurse (RN) who visit the facility regularly and has not witness facility staff yelling at residents. RN stated that the days that RN is at the facility RN has only witnessed the staff being friendly to residents and puts the residents needs first even when outside agency are present and needs assistant. In addition, interview with the ombudsman, it was learned that ombudsman has no concerns with the facility through observations when the ombudsman’s been at the facility. Based on the interviews and statements obtained during the investigation process, the allegation has not been corroborated. The allegation that staff inappropriately disciplined residents in care is determined to be unsubstantiated.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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