405850007-5-17-2022-29-AS-KBUY-CES2UU-20220525174256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850007
Report Date: 05/17/2022
Date Signed: 05/17/2022 02:59:46 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
10/21/2020 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20201021151535

FACILITY NAME:	BELLA VITA SENIOR LIVING		FACILITY NUMBER:	405850007
ADMINISTRATOR:	BUDAI, KAROLY		FACILITY TYPE:	740
ADDRESS:	145 ANDRE DRIVE		TELEPHONE:	(310) 500-6461
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY:	6	CENSUS: 5	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Karoly (Robert) Budai/Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility does not have a sufficient quantity and variety of non-perishable food items.

INVESTIGATION FINDINGS:

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At 2:45pm on 05/17/2022, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility to issue the final findings of this complaint allegation. LPA met with Administrator Karoly (Robert) Budai and explained the purpose of the visit.
Based on interviews, observation, documentation, four week duration of weekly grocery receipt audit and photographic evidence LPA did not have enough evidence to substantiate the allegation of, "Facility does not have a sufficient quantity and variety of non-perishable food items." at this time. Two physical visits, photographs of sufficient perishable and non-perishable foods, 4 weeks of grocery receipts, interviews of staff and residents revealed no evidence of insufficient food quantity with regards to perishable and non-perishable food supplies for up to 6 residents; therefore, the allegation of, Facility does not have a sufficient quantity and variety of non-perishable food items, is unsubstantiated at this time.

Exit interview, report signed and provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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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