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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005327
Report Date: 08/02/2024
Date Signed: 08/02/2024 03:33:09 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
06/14/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240614140439
FACILITY NAME:ST. MARY'S HOME AT BELLFACILITY NUMBER:
347005327
ADMINISTRATOR:NAZARINA DE VERAFACILITY TYPE:
735
ADDRESS:1347 BELL STREETTELEPHONE:
(916) 865-7947
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:14CENSUS: 14DATE:
08/02/2024
UNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Mick LegacionTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff threw away resident’s personal belongings.
INVESTIGATION FINDINGS:
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On 8-2-24 at 2:33pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with lead caregiver and explained the purpose of the visit. Administrator Nazarina De Vera was made aware of LPA's visit via phone and gave permission for lead caregiver to sign in her absence. During this investigation, LPA conducted interviews with three staff members, complainant, and two additional witnesses. LPA also reviewed facility file documentation including physician’s report, admissions agreement, and facility care notes pertaining to resident1 (R1).
Based on interviews and record reviews it was determined that in April 2024, R1 was admitted to a local hospital and discharged from facility. It was further revealed that personal items belonging to R1 were claimed to have been left at the facility upon R1’s discharge and thrown away by facility thereafter. Interview conducted revealed that R1’s items were gathered by facility staff and picked up by R1’s caseworker after R1’s discharge for purposes of delivering to R1. Additional interviews and record reviews revealed no corroborated evidence to prove any personal items were thrown away by facility staff after R1’s discharge.
{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
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 2
Control Number 27-AS-20240614140439
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: ST. MARY'S HOME AT BELL
FACILITY NUMBER: 347005327
VISIT DATE: 08/02/2024
NARRATIVE
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 As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with lead caregiver and a copy of this report was provided to. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2