565800983-8-31-2021-29-AS-DPEA-C85V27-20211025160237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800983
Report Date: 08/31/2021
Date Signed: 08/31/2021 04:26:37 PM

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
11/20/2020 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20201120163246

FACILITY NAME:	LINA'S GUEST HOME		FACILITY NUMBER:	565800983
ADMINISTRATOR:	CELINA B. ALBUNA		FACILITY TYPE:	740
ADDRESS:	2221 KEPLER DRIVE		TELEPHONE:	(805) 487-3816
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	6	CENSUS: 5	DATE:	08/31/2021
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Lina Albuna		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident is not being properly fed while in care
Staff failed to address resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today due to allegations listed above. The LPA met with Administrator Lina Albuna at 10:08 AM and explained the reason for the visit.

Prior to today's inspection, a virtual inspection was conducted on 11/23/2020 beginning at 11:01 AM. During the virtual inspection, the LPA conducted a Face Time interview with Resident #1 (R1) at 2:23 PM, interviewed the administrator and conducted a physical plant tour. During the tour, the LPA observed a sufficient supply of perishable and non-perishable foods, including a variety of fruits, vegetables, dairy, and protein items.

During today's inspection, beginning at 10:18 AM the LPA conducted a physical plant tour. The facility has a sufficient supply of perishable and non-perishable food and a variety of foods to be served. At 10:19 AM the LPA observed Resident #1 (R1) in their bedroom. Report continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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-20201120163246

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: LINA'S GUEST HOME	FACILITY NUMBER: 565800983
	VISIT DATE: 08/31/2021

NARRATIVE

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At 10:33 AM, the LPA began reviewing facility records for R1. At 12:16 PM the LPA conducted an interview with R1 and at 12:25 PM the LPA conducted an interview with Administrator Lina Albuna. At 12:55 PM the LPA conducted an interview with Resident #2 (R2). The LPA is unable to interview the other residents in the home due to their diagnosis'.

The allegation of 'Resident is not being properly fed while in care' alleges R1 eats cup of noodles for most of their meals. Both interviews with R1 revealed had no complaints regarding the food R1 is being served. R1 stated they could only eat soft food due to dental issues but stated they receive a variety of foods to eat including egg and cheese omelets, sandwiches, Salisbury steak, cup of noodle soup, tomato soup, oatmeal, fruit, and yogurt. The interview with R2 revealed they were happy with the food being served and they received a variety of well balanced meals. Interviews with the Administrator revealed she bought cup of noodles for R1 pursuant to R1's request in the past but stated this was not the only food item R1 eats and stated R1 is served a variety of soft foods. Based upon the LPA's observation of the food supply and the interviews conducted, the allegation of 'Resident is not being properly fed while in care' is deemed unsubstantiated at this time.

The allegation of 'Staff failed to address resident's hygiene needs' alleges R1 was observed to be disheveled, with matted hair, and un-hygienic. During the virtual face time interview and during today's inspection, the LPA observed R1 to have clean clothes and combed hair. During the 11/23/2020 interview with R1, they stated they are bathed in bed one time a week due to not being able to stand up at the time. During today's interview, R1 stated they are now able to stand and receive a shower in the bathroom two times a week. During the interview with Administrator on 11/23/2020, she stated the resident is getting sponge baths twice a week due to being unstable when walking. During today's interview, the Administrator stated R1 is able to walk now with assistance and receives a shower two times a week. The LPA observed all five residents in the facility to be in clean clothes and groomed appropriately with combed hair and clean faces. Based upon interviews and observation, the allegation of 'Staff failed to address resident's hygiene needs' is deemed unsubstantiated at this time.

Exit interview conducted and report reviewed with the Administrator. A copy of the report and appeal rights will be emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC9099 (FAS) - (06/04)

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