405801512-12-19-2025-29-AS-KBUY-DPTRFU-20251229115944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405801512
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:17:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2025 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20251216083206

FACILITY NAME:	WELCOME HOME RESIDENTIAL CARE FOR THE ELDERLY		FACILITY NUMBER:	405801512
ADMINISTRATOR:	EVELYN I. FLORENTINO		FACILITY TYPE:	740
ADDRESS:	402 WOODBRIDGE ST.		TELEPHONE:	(805) 784-0540
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	6	CENSUS: 3	DATE:	12/19/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Evelyn Florentino		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff did not provide resident with appropriate sleeping accommodations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA was greeted by staff whom called Administrator and Administrator arrived shortly after. LPA explained the purpose of the visit to Administrator Evelyn Florentino.

LPA De Leon took a tour of the resident bedrooms, took video and photos of the bed working, requested records and interviewed Administrator at 10:55 am, staff at 11:01am, witnesses at 11:50am and 1:00pm and residents at 10:48am and 11:59am.

On the allegation: Staff did not provide resident with appropriate sleeping accommodations. LPA De Leon reviewed 3 resident Admission Agreements which revealed the Admission Agreement Pg. 3 Basic Services section (b) Safe and Healthful accommodations 1. Comfortable bed and suitable bedroom furniture.

Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

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 29-AS-20251216083206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: WELCOME HOME RESIDENTIAL CARE FOR THE ELDERLY	FACILITY NUMBER: 405801512
	VISIT DATE: 12/19/2025

NARRATIVE

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LPA interviewed residents which revealed Resident 1 (R1) was admitted to the facility on 11/17/2024 and brought R1's own hospital bed that had been purchased in 2020 in Oregon years prior to move in. The lower section of the bed is not working properly and R1 feels the facility knows how to fix it and is just not fixing it for R1.

LPA conducted interview with Administrator which revealed Resident 1 (R1) brought in R1's own bed at admissions. The bed is a hospital bed and is not working correctly, the knee parts motor is going out and it will not work to lift and lower the knee section of the bed at all times. Administrator called several local businesses to see if they could fix the bed but due to it not being purchased from those companies they can not service it. Administrator notified family that is was not working correctly and family said they would take care of it. The facility staff contacted the manufacturer of the bed and on speaker phone walked the staff and R1 thorough the steps to try to lower the knee section of the bed, the staff was able to get the bed lowered so it can be used properly but the knee section motor is going out so it works at times and then doesn't at times to lift and lower the knee section of the bed. The Administrator offered to purchase a new bed from BestCare Pharmacy but R1 does not want the facility to purchase a new bed, R1 wants R1's bed fixed. the facility will do whatever is needed to accommodate R1 unfortunately the bed will probably need to be replaced as it can not be fixed and R1's family is aware and working on their end to get a replacement that will satisfy R1. R1 does have appropriate sleeping accommodations at this time.

LPA conducted interview with staff 2 (S2) which revealed the staff contacted the manufacture of the bed and went through the steps of trying to fix it on speaker phone, the staff was able to go under the bed and fix the knee part to lower so the bed can be used but the knee section motor is not working properly all the time so it gets stuck in the higher or lower positon of the knee section. The manufacturer said it could be the knee section motor is going out and will need to be replaced or a new bed purchased and the company can not do anything for R1. The staff offered a bed that is stored in the garage but R1 refused the bed, the staff said they could purchase a new one and R1 said no R1 wants R1's bed fixed. The facility is unable to make that happen after several phone calls to the manufacturer. S2 talked to R1 and said that if R1 wants R1 knees raised and the bed is not working they can place pillows or cushions to elevate R1's knees and feet but that is not what R1 wants, R1 wants the bed fixed.

Continued 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20251216083206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: WELCOME HOME RESIDENTIAL CARE FOR THE ELDERLY	FACILITY NUMBER: 405801512
	VISIT DATE: 12/19/2025

NARRATIVE

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LPA interviewed Witness 1 (W1) that stated the facility did make contact about the bed and W1 was looking into a replacement bed with the Veterans Association (VA) as the VA is who purchased the original bed and will find out if they can replace it due to it not working properly. W1 said the facility is doing what they can to accommodate R1 and R1 does have a bed to sleep in, it is just not functioning how it should and R1 wants the bed fixed not replaced. W1 will talk to R1 and explain that it may just need to be replaced and is working with the VA to get a replacement if that is what is needed. W1 will work with the facility and R1 to get this taken care of.

LPA interviewed Witness 2 (W2) and W2 stated the facility does accommodate Resident 2(R2), the staff are great and attentive to W2's needs and they do contact W2 if something is needed for R2. R2 is always dressed and ready for visits and appointments. R2 does have visitors regularly and all reports to W1 have been great at the facility. W2 does not have any issues or complaints with the facility.

LPA interviewed Resident 2 (R2) which revealed the staff are wonderful, always take care of R2's needs and R2 has never had any issues or complaints with the facility.

Based on the evidence R1 has a bed to accommodate R1 at this time, the bed knee lift and lower is not working properly at all times, R1 has refused a new bed and a bed that is in storage, The facility has contacted everyone possible to get the bed fixed and has not been able to find anyone that can fix it, the motor is warring out and eventually will stop working at some point, W1 is working on getting a replacement bed for R1 through the VA. LPA observed the bed knee area to be working properly at the time of the visit. The facility has tried to accommodate R1 in every way but R1 wants R1's bed fixed and does not want a used bed or a new bed therefore this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

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