374604383-3-11-2024-08-AS-LTEZ-D3QPXW-20240326114301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604383
Report Date: 03/11/2024
Date Signed: 03/11/2024 02:10:51 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2024 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20240307134151

FACILITY NAME:	AMARIAH HOME CARE		FACILITY NUMBER:	374604383
ADMINISTRATOR:	JR. ALVELA, JOSEPH P.		FACILITY TYPE:	740
ADDRESS:	1046 HELIX AVE		TELEPHONE:	(619) 731-1535
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	6	CENSUS: 5	DATE:	03/11/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Caregiver Mary Phets		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee unlawfully initiated a resident eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to investigate the above complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Mary Phets. LPA also spoke via phone with Licensee Joseph Alvela during today’s visit.

It was alleged that Licensee unlawfully initiated an eviction action against Resident #1 (R1). [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an unannounced facility tour / welfare check, a review of facility records and electronic correspondence, and interviews pertinent facility staff and outside sources.

[CONTINUED ON LIC 9099-C]

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

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 08-AS-20240307134151

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: AMARIAH HOME CARE	FACILITY NUMBER: 374604383
	VISIT DATE: 03/11/2024

NARRATIVE

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[CONTINUED FROM LIC 9099]

On 02/26/2024, Licensee sent a cell phone text message R1 and their responsible person (RP). [R1 and their RP were not served a written letter.] In this text message, which CCLD obtained, Licensee wrote that R1 had experienced “mobility changes” and that they required “2 person assist for all activities [of daily living].” Licensee further wrote that R1 needed to move out by “the end of March or until you find a suitable place in or close to that date.” Licensee’s text message did not contain the elements, disclosures, and supporting documents which are required during eviction action. Written notice of the planned action was not provided to CCLD, as was required.

Interviews of Licensee, facility line staff, and outside sources, which were supported by care records, showed: R1 moved into the facility around two years ago. Since the time R1 moved in, to the present time, R1 has continuously relied on a wheelchair for mobility and required a hoyer-lift machine to transfer from bed to wheelchair, and vice versa.

Per the Licensee, they did not conduct a recent reappraisal of R1’s care needs. They confirmed to LPA that R1’s inherent mobility and transferring abilities have not recently changed; rather, the overall caregiver staffing pool at the facility has diminished, making caring for R1 more challenging.

Based on interviews and records, a preponderance of evidence exists to show that Licensee’s unlawfully initiated an eviction action against R1. The allegation is therefore substantiated. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Alvela, to whom a copy of this report, the LIC 9099-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240307134151

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: AMARIAH HOME CARE	FACILITY NUMBER: 374604383
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/15/2024 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	87224 Eviction Procedures: “(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified… (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.”	1 2 3 4 5 6 7	During today’s visit, LPA provided Licensee with the full text of Regulation 87224 Eviction Procedures. Licensee agreed to notify R1 and their responsible person (via a letter) that due to the current staffing challenges at the facility, “voluntary relocation” of R1 is recommended as soon as possible, but there is no deadline set. Licensee agreed to arrange for at least two (2) staff to be present inside the facility during the typical hours when R1 needs to be transferred via hoyer lift in connection with their dialysis appointments (i.e., early mornings and early afternoons, every Monday, Wednesday, and Friday), hiring contracted caregivers from outside licensed home care organizations if needed. Licensee agreed to E-mail a copy of the letter and an updated LIC500 Personnel Report (to evidence the increased staffing) to LPA, by the POC due date.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by: Based on records and interviews, Licensee initiated eviction proceedings against 1 of 5 residents (R1) on the basis of a need not previously identified, without performing a reappraisal pursuant to Section 87463 and providing a thirty (30) days written notice letter to the resident. This posed a potential personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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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.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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