342700921-4-22-2022-27-AS-SDOB-CDULGK-20220426084453

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700921
Report Date: 04/22/2022
Date Signed: 04/22/2022 09:55:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2022 and conducted by Evaluator Anthony Tuck

COMPLAINT CONTROL NUMBER: 27-AS-20220404102952

FACILITY NAME:	VITA BELLA ELDERLY CARE II		FACILITY NUMBER:	342700921
ADMINISTRATOR:	DIANA GARCIA		FACILITY TYPE:	740
ADDRESS:	8362 NEW POINT DR		TELEPHONE:	(916) 821-4423
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	6	CENSUS: 6	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Mark Labella		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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staff are not providing adequate care to resident
facility is not adequately staffed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anthony Tuck arrived at facility location on 04/22/2022 and was met by Licensee Mark Labella. LPA explained the purpose of today’s visit to conclude findings on the complaint allegations listed above.

LPA conducted an initial investigation on 04/13/2022 and conducted interviews with 5 residents and 2 staff. LPA obtained and reviewed copies of LIC 625’s for 6 residents. LPA obtained and reviewed copies of LIC 602 for 2 residents. LPA obtained and reviewed copies of ongoing caregiver notes. LPA obtained a copy of the LIC 500. LPA learned from an interview with resident (R1) that he enjoys living at the facility and that the staff take good care of him R1 stated that there are always 2 staff working at the facility every day. LPA confirmed with other residents during interviews that the facility always has 2 staff working each day. LPA conducted an additional visit on 04/14/2022 and interviewed staff S3.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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 27-AS-20220404102952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: VITA BELLA ELDERLY CARE II	FACILITY NUMBER: 342700921
	VISIT DATE: 04/22/2022

NARRATIVE

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LPA learned from one resident (R3) that staff don’t take him to the bathroom and staff don’t check on him during the night. LPA reviewed LIC 602 for this resident and learned that R3 is diagnosed with delusional schizophrenia and dementia. LPA learned from staff that R3 can be verbally abusive and has issues with his memory. LPA confirmed behaviors of R3 during an interview based on LIC 602 and LIC 625.

LPA reviewed copy of the LIC 500 and learned that the facility has 2 care givers working each day except on weekends. LPA learned from an interview with staff (S3) that the facility will provide additional coverage as needed on the weekends to relieve the care staff for breaks. LPA learned from an interview with resident (R5) that for a while the facility only had 1 care staff working every day, but now the facility has 2 every day. LPA learned from R5 that the staff do a good job taking care of her needs, but they don’t always come to clear her food dishes when she is through with her meals. LPA learned from an interview with staff (S1) that R5 tends to take her time while eating so they don’t come to clear her dishes right away, so she does not feel rushed when staff are trying to clean up and run the dish washer. LPA learned from an interview with S1 that resident (R1) had a tear in his jacket when he moved into the care home but it’s his favorite jacket. LPA learned from interviews conducted with R1, R2 and R4 that the care staff do a good job taking care of their needs. LPA learned from R5, that when she has an issue with staff the administrator ensures that her concerns are taken care of.

Upon review of interviews documentation, there is not substantial evidence to support or disprove that the alleged violations occurred. Due to the preponderance of evidence standard not being met by the department standard. There is no physical evidence to support the validity of the allegations as well as witness statements; LPA has deemed the complaint findings as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Licensee Mark Labella, a copy of the report was provided upon exit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony Tuck	TELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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