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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366400050
Report Date: 06/05/2024
Date Signed: 06/05/2024 11:22:47 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, 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
05/31/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240531130519
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:
06/05/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Tita An, Licensee TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not serve residents foods free from contamination
Staff are not meeting residents' dietary needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Licensee Tita An and explained the elements of the visit.

Regarding the allegation that staff do not serve residents foods free from contamination; LPA Prieto interviewed licensee about the process in the preparation of her resident's (R1) lunch to Day Program. Licensee states that R1's food is sent in a insulated lunch bag with an ice pack to keep the food fresh and free from being contaminated. Meal in question, for this investigation, was sent, frozen in the lunch box, to be heated before consuming while at R1's Day Program.
***Continued on LIC 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 56-AS-20240531130519
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: 06/05/2024
NARRATIVE
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Third party witness interviewed by LPA Prieto, stated that R1, heats the meals as soon as they arrive to the Day Program, that my cause contamination, but food is not being sent to the Day Program contaminated.

Regarding the allegation that staff are not meeting residents' dietary needs; LPA Prieto observed facility refrigerator and freezer and see that they have the appropriate amount of perishables and non-perishables. LPA also observed fresh fruit place on the kitchen counter as well.

Based on the information obtained there is not enough evidence that staff do not serve residents foods free from contamination and staff are not meeting residents' dietary needs. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. A copy of this report was signed by LPA Prieto and licensee Tita and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2