425850218-12-5-2023-29-AS-KBUY-CYQ2WX-20231220164618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850218
Report Date: 12/05/2023
Date Signed: 12/05/2023 11:12:16 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, 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
05/31/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230531110058

FACILITY NAME:	VILLA-CARE HOME II		FACILITY NUMBER:	425850218
ADMINISTRATOR:	VILLAROS, JENNIFER		FACILITY TYPE:	740
ADDRESS:	946 WEST BUNNY		TELEPHONE:	(805) 614-4442
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	6	CENSUS: 6	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Luciana Oani, Staff and Jennifer Villaros, Administrator over the phone		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff are unable to communicate due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA Chavez conducted the investigation, reviewed facility documents and conducted interviews with the staff and residents. LPA Chavez interviewed staff and residents on 6/8/23. LPA Olson interviewed residents on 12/5/23. LPA met with Staff and Administrator over the phone and informed them the reason for the visit.

On the allegation: Staff handled resident in a rough manner. It was alleged that staff tossed Resident 1 (R1) around and are mean to R1. R1 had a bruise on their right arm from an IV taken out the previous week. It was also reported that staff didn’t seem to care about the residents needs or concerns. On 6/8/23 LPA Chavez went to the facility for the unannounced initial visit and was greeted by Staff 1 (S1) and Resident 2 (R2). LPA Chaves observed S1 tell R2 to “get back and go away.” LPA interviewed R2 at 1:31pm who stated they do not like S1 because they are mean to R2. At 1:45pm LPA observed Resident 3 (R3) stand up and R2 stated “do you want to see who she [LPA] is?”
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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-20230531110058

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: VILLA-CARE HOME II	FACILITY NUMBER: 425850218
	VISIT DATE: 12/05/2023

NARRATIVE

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S1 went over to residents and R2 stated “ you won’t even let [R3] see who she is, you’re a mean lady. Do you know you’re a mean lady?”. S1 responded, yes I’m a mean lady.” Interview with Administrator and Licensee revealed that R1 had a psychotic breakdown and was admitted to a mental institution on 6/5/23. R1 was bolting out the door and staff tried to get R1 back in the house, and grabbed R1’s arm to get R1 back. Administrator stated that R1 told them Staff 2 (S2) was mean to R1. Administrator explained there was tension between them because R1 wanted their medication earlier then prescribed and S2 wouldn’t give them to R1. R1 was still at the hospital and not available to speak with at the time of the visit. LPA Olson interviewed residents who stated staff do not rough handle them. Based on the information obtained, there was insufficient evidence to prove that staff handled a resident in a rough manner. However, a Case Management visit will be conducted to address the other personal rights violations discovered during the investigation.

On the allegation: Staff are unable to communicate due to language barrier. It was alleged that staff could not speak English. LPA Chavez observed S1 spoke broken English but was able to answer questions, but sometimes had to ask the question twice. S1 stated they moved from the Philippines several years ago to be closer to family. LPA Olson interviewed residents who stated they are able to communicate with staff to get their needs met. Based on the information obtained the allegation is deemed Unsubstantiated..

Exit interview conducted, copy of report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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