374603585-11-21-2023-18-AS-JDHS-D7PLZ5-20240731091123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603585
Report Date: 11/21/2023
Date Signed: 11/21/2023 02:36:58 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231120102151

FACILITY NAME:	ALVIN'S HOMECARE		FACILITY NUMBER:	374603585
ADMINISTRATOR:	JOHN BULAORO		FACILITY TYPE:	740
ADDRESS:	724 DRIFTWOOD LANE		TELEPHONE:	(760) 990-4694
CITY:	FALLBROOK	STATE: CA	ZIP CODE:	92028
CAPACITY:	6	CENSUS: 5	DATE:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Jospehine Bulaoro, Caregiver		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee is not operating the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA)s, Jesse Gardner and Javina George, conducted an unannounced visit to the facility to initiate the investigation into the allegation listed above, The LPAs met with Caregiver Josephine Bulaoro and informed her of the purpose of LPAs visit. The Administrator was unavailable to come to the facility but was available via telephone.

On 11/20/23, The department received a complaint alleging that the Licensee was not operating the facility. LPAs Gardner and George conducted a tour of the interior and exterior of the facility, interviews with residents and (5) facility staff in addition to the Licensee/Administrator, as well as conducted a records review. LPA conducted a records review that revealed the home was recently sold on 10/27/23. Per the Licensee Mr. John Bulaoro confirmed that the home was recently sold to a family member and that he is still operating the facility until the change of ownership is completed. Mr. Bulaoro stated that he is at the facility daily during the week in the evenings (5pm-10pm) sometimes later, and on the weekends as early as 8am staying all day or until 2pm, if not later depending on the needs of the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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 18-AS-20231120102151

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALVIN'S HOMECARE	FACILITY NUMBER: 374603585
	VISIT DATE: 11/21/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	This information was corroborated by staff interviews that were conducted. Based on observation and interviews the allegation is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to Josephine Bulaoro.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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