425801981-6-11-2024-29-AS-KBUY-D6EW2N-20240620165436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801981
Report Date: 06/11/2024
Date Signed: 06/11/2024 01:14:30 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
05/23/2024 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20240523111307

FACILITY NAME:	YOUR HOME, RCFE		FACILITY NUMBER:	425801981
ADMINISTRATOR:	VIKTORIIA ANDREICHENKO		FACILITY TYPE:	740
ADDRESS:	128 SAN RAFAEL AVENUE		TELEPHONE:	(805) 965-3885
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93109
CAPACITY:	6	CENSUS: 5	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:			TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff handled resident roughly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver final findings for the above allegation. The initial visit was conducted on 5/29/2022 by LPA Kristin Kontilis, and LPA interviewed residents and staff from 10:30 am to 2:30 pm. During today’s visit, LPA met with Viktoriia Andreinchenko and explained the reason for the visit.

On the allegation: Staff handled resident roughly. It was alleged that Resident 1 (R1) sustained bruising of unknown origin on their right side of chest and arm. It was described as a round bruise. R1 mainly speaks Spanish, but is alert enough to talk and have a conversation. A witness stated sometimes R1 is resistant to care. Staff stated R1 can be “feisty” and hit against staff while providing care. Staff observed the bruise on R1 and were initially unsure of it’s origin because R1 stated it was “from surgery.” Staff later thought the bruising might be from transferring R1, due to the location of the bruises on R1’s sides and arms. Staff

Please continue to 9099-C, Pg 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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 29-AS-20240523111307

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: YOUR HOME, RCFE	FACILITY NUMBER: 425801981
	VISIT DATE: 06/11/2024

NARRATIVE

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stated R1 does not assist them with transfers but rather pushes their weight against the staff, which may be the cause of the bruising. Staff and administrator demonstrated their transfer process for LPA. Staff and administrator have decided to add towels on the staff’s arms, to provide padding for staff that put their arms under R1’s arms for transfers. They are also implementing a new transfer, where they ask R1 to put their arms around the staff’s neck during the transfer. LPA noted R1 is on blood thinners, and interviews revealed R1 could bruise easily as a result. LPA attempted to interview R1, but R1 stated in Spanish “no preguntas” (no questions). R1 had a visitor on 5/18/2024 that did not observe any bruising. R1’s family member stated on 5/29/2024 that they had no concerns about R1’s care.

Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report issued at the time of the visit.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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