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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:28:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20240722092351
FACILITY NAME:BAY BREEZE CAREFACILITY NUMBER:
191600093
ADMINISTRATOR:DIMATULAC, RODOLFOFACILITY TYPE:
735
ADDRESS:1653- 55 SANTA FE AVETELEPHONE:
(562) 432-8033
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:76CENSUS: 61DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator - Rodolfo DimatulacTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Illegal eviction
Due to short staff, residents are not getting medications
Due to short staff, resident meals are not timely
Due to short staff, facility is not cleaned properly
INVESTIGATION FINDINGS:
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On 07/23/2024 at around 8:00 AM Licensing Program Analyst (LPA), Leandro initiated a complaint investigation regarding the allegations listed above. LPA met with Administrator, Rodolfo Dimatulac and the purpose of the visit was explained.

The investigation consisted of the following:
During today’s investigation LPA and Administrator conducted a tour of the facility which included checking random client bedrooms, medication room, kitchen, dining rooms, and facility bathrooms. LPA interviewed 7 out of 61 clients and 5 out of 13 staff. LPA received facility records which consisted of Personnel Report, New Staff information, Resident Roster, House Rules, Employee Schedule, Facility Meal Menu Calendar, Kitchens Sanitation & Safety Report, Client 1’s (C1) Records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20240722092351
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BAY BREEZE CARE
FACILITY NUMBER: 191600093
VISIT DATE: 07/23/2024
NARRATIVE
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The investigation revealed the following:

Regarding the allegation “Illegal eviction,” it is being alleged that C1 received an eviction letter on 07/11/2024 and feels that the eviction letter was out of retaliation. Records review reveal, that C1 did receive a 30-day Eviction Notice on 7/11/2024 and R1 refused to sign the document. Moreover, Unusual Incident Reports reveal that C1 has a history of aggression and physical violence toward clients, staff members, and visitors dating from November 2023 to July 2024. Furthermore, the facility faxed C1’s 30-day Eviction Notice to Community Care Licensing thus, following the California Code of Regulations, Title 22. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Due to short staff, residents are not getting medications,” it is being alleged that due to short staff clients are not getting their medications. 7 out of 7 clients indicated that clients get their medication. 5 out of 5 staff indicated that clients get their medication. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Due to short staff, resident meals are not timely,” it is being alleged that due to not having enough staff meals are being served late to clients in care. 7 out of 7 clients indicated that they do not wait long for their meals. 5 out 5 staff indicated that the facility follows their meal schedule. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Due to short staff, facility is not cleaned properly,” it is being alleged that due to short staff, staff are not cleaning up after clients in care. 6 out of 7 clients indicated that staff cleans their rooms and facility bathrooms every day. 5 out 5 staff indicated that facility rooms, hallways and bathrooms get cleaned every day; moreover, facility bathrooms get checked every two to one hour. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No deficiencies were cited.
An exit interview was conducted, and a copy of this report was left with the Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2