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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601080
Report Date: 05/17/2022
Date Signed: 05/17/2022 11:54:08 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20220504161931
FACILITY NAME:VISTA TERRACE OF BELMONTFACILITY NUMBER:
415601080
ADMINISTRATOR:MICHAEL LIFACILITY TYPE:
740
ADDRESS:900 SIXTH AVENUETELEPHONE:
(650) 591-2008
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:68CENSUS: 46DATE:
05/17/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Interim Administrator, Ryan MussatoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Staff did not assist residents with scheduling an appointment
INVESTIGATION FINDINGS:
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2
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13
On May 17, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Interim Administrator, Ryan Mussato, and explained the purpose of the visit.

Complainant alleged that staff did not assist residents with scheduling the second COVID-19 booster shots. During this investigation, LPA interviewed the Interim Administrator, who indicated that scheduling mass clinics at the facility is not part of their facility mitigation plan. The interim administrator also indicated that the facility has contacted multiple vendors in order to facilitate boosters, but due to the COVID outbreak at the facility, vendors will not come until the facility is cleared by Public Health. It was also indicated that, at the moment, the resident’s responsible parties have been scheduling the resident’s appointments for a second booster shots.

The complainant concern is that the facility has been experiencing internal turmoil due to managerial transition. The complainant's concern is that due to this transition, the facility is failing to schedule mass clinic for residents to get the second booster.

It is noted that Regulations require licensees to facilitate medical appointments and follow ups for residents; however, there are no Regulations requiring the facility to schedule mass clinics. During the pandemic, the facilities were required to follow directives from the local health departments to facilitate vaccinations; however, there are no active directives from San Mateo County to coordinate mass clinics for boosters at this time. Based on the documents reviewed and interviews conducted, we have found that the complaint was unsubstantiated.

Report was reviewed with Interim Administrator and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
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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