421703043-9-1-2021-29-AS-KBUY-C7E289-20211001170959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421703043
Report Date: 09/01/2021
Date Signed: 09/01/2021 11:00:57 AM

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
08/19/2020 and conducted by Evaluator Arien Diaz

COMPLAINT CONTROL NUMBER: 29-AS-20200819164551

FACILITY NAME:	AVE'S BOARD AND CARE		FACILITY NUMBER:	421703043
ADMINISTRATOR:	THELMA TABLADA		FACILITY TYPE:	740
ADDRESS:	111 CRESCENT AVE		TELEPHONE:	(805) 332-3139
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	6	CENSUS: 6	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Thelma Tablada		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Facility installed ramps which create hazards to the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diaz conducted a complaint visit to deliver final findings of the complaint investigation conducted by LPA Diaz.

On the allegation: Facility installed ramps which create hazards to the residents. LPA Diaz toured the facility and conducted interviews with staff and residents. LPA interviewed residents on 7/29/2021 at 12:38pm, and 12:58pm. LPA interviewed staff on 7/11/2021 at 6:30pm and on 7/29/2021 at 1:00pm 1:20 and 1:33pm. LPA toured the physical environment, and accommodations were assessed. LPA observed and photographed an outside ramp at the entrance of the facility. The ramp was approximately 14 feet long and about 7 inches high at the top of the ramp. LPA observed one small handrail near the outside ramp. LPA also observed and photographed a 4-foot ramp inside the entrance of the facility leading from the door to the living of the house. The inside ramp was about 5 inches high at the top of the ramp. The physical environment was checked. The floors, walls, windows, ceilings, bathrooms, kitchen, pantry, and storage rooms were checked.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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 29-AS-20200819164551

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: AVE'S BOARD AND CARE	FACILITY NUMBER: 421703043
	VISIT DATE: 09/01/2021

NARRATIVE

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The facility was seen to be in good repair inside and outside. 2 out of 2 residents stated they like living at the facility and they have no problems with both ramps. 1 out of 2 residents stated they have never seen anyone in the facility trip on any ramp. Resident 1 (R1) stated on one occasion they rolled their walker off the side of the ramp but admitted it was their fault and not due to the ramp, and they did not fall or lose their balance. R1 stated that the ramps do not endanger the residents. R1 also stated residents are closely watched and consistently assisted by staff to prevent any harm. All staff interviewed stated that they have never seen anyone trip or fall using the ramps and the ramps are not hazardous. Staff stated they frequently monitor the residents throughout their shift. The Administrator and Licensee stated that Community Care Licensing recommended to build the ramps for residents in the facility. The Administrator and Licensee offered to install additional handrails for the safety of the residents. Based on the interviews and observation, the allegation: Facility installed ramps which create hazards to the residents is deemed unsubstantiated at this time.

exit interview, report emailed

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

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