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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366400050
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:00:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240222120216
FACILITY NAME:VINMAR CARE HOME INC.FACILITY NUMBER:
366400050
ADMINISTRATOR:TITA OLIVIA ANFACILITY TYPE:
735
ADDRESS:8614 VINMAR AVENUETELEPHONE:
(909) 981-2096
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:6CENSUS: 1DATE:
02/28/2024
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Tita An, Administrator TIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff fed resident food that was not of good quality
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with administrator An and explained the elements of the visit.

Regarding the allegation that Staff fed resident food that was not of good quality; Administrator An stated that she was aware that a sandwich, in consumer's lunch box, was made the previous day. An states she was not aware that the food had spoiled and left with the consumer to Day Program the following day. The lunchbox did not contain cooling source causing the food to spoil. The food was not consumed.

***continued on LIC 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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 56-AS-20240222120216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: VINMAR CARE HOME INC.
FACILITY NUMBER: 366400050
VISIT DATE: 02/28/2024
NARRATIVE
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Based on LPA observations, interviews which were conducted and records review, the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division) are being cited on the attached LIC 9099D).
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240222120216
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VINMAR CARE HOME INC.
FACILITY NUMBER: 366400050
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2024
Section Cited
CCR
80076(a)(1)
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FOOD SERVICES
All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients.
This was not met as evidenced by:
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Administrator gave written statement to LPA on properly cooling meals to prevent spoilage on this date.
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Administrator was aware that a meal was prepared 24 hours prior, without a cooling source, causing the food to spoil. Administrator admits that this was an error on her part.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3