342700921-7-20-2022-27-AS-KHOS-CGPTBC-20220726143454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700921
Report Date: 07/20/2022
Date Signed: 07/20/2022 02:35:33 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, 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
07/18/2022 and conducted by Evaluator Avelina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220718105537

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: 5	DATE:	07/20/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Diana Garcia		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are restricting resident from exercising before noon.

INVESTIGATION FINDINGS:

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On 07-20-2022 at 1:00 PM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit in regards to a complaint investigation with the above allegation. LPA Martinez met with Diana Garcia and explained the purpose of today's visit.

Throughout the investigation, LPA Martinez interviewed residents and staff and reviewed facility documents. LPA Martinez interviewed three residents. All three residents reported being able to exercise in the morning. Resident 1 (R1) reported having no issues with facility staff and receives good service and food. R1 also reported being able to exercise at any time and walks in facility because its too hot outside. In addition, LPA Martinez interviewed two staff, both staff reported residents exercise at any time during the day. One facility exercise session involves residents walking to the mailbox with staff. LPA Martinez observed pictures of residents exercising with staff at the facility.

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

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-20220718105537

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: 07/20/2022

NARRATIVE

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Moreover, LPA Martinez observed R1 walking around the facility, and R1 was able to go out to back yard independently and walk around the yard. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to facility at the end of this visit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022

LIC9099 (FAS) - (06/04)

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