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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609345
Report Date: 07/09/2024
Date Signed: 07/09/2024 12:45:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2024 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20240705080208
FACILITY NAME:CASA AMOREFACILITY NUMBER:
197609345
ADMINISTRATOR:MORALES, RITAFACILITY TYPE:
740
ADDRESS:44124 WESTRIDGE DRIVETELEPHONE:
(661) 289-0288
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 5DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Melissa Gile (Caregiver)TIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Facility staff are not maintaining tight covered lids on bathroom trash bins.
Facility staff do not keep medication in a safe and locked location.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced complaint investigation. Upon arrival, LPA was greeted by caregiver, Melissa Gile. Caregiver contacted the administrator Rita Morales. LPA explained to the administrator the purpose of the visit over the telephone. Rita met LPA shortly after. Rita could not stay for the visit and designated caregiver, Melissa Gile to sign todays report.

At 9:50 a.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation#1: Facility staff e not maintaining tight covered lids on bathroom trash bins.
It is alleged, trash bin in the one (1) bathroom is without a tight fitting lid. To investigate the allegation, LPA Rios interviewed the administrator at approximately 9:55 a.m. According to the administrator the trash bin in the bathroom does have a swinging lid but residents tend to find it difficult to use and will dispose of items in the toilet which has caused the toilet to clog. (Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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 3
Control Number 31-AS-20240705080208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA AMORE
FACILITY NUMBER: 197609345
VISIT DATE: 07/09/2024
NARRATIVE
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At 10:03 a.m. LPA observed one (1) of two (2) bathrooms had a trash bin with no lid or cover. Based on interview conducted, and LPA's observation the allegation is deemed Substantiated at this time.
Allegation#2: Facility staff do not keep medication in a safe and locked location.
It is alleged, medication closet and medication requiring refrigeration were not secured. To investigate the allegation, LPA Rios conducted a physical plant tour and reviewed four (4) of five (5) resident physician's reports. Two (2) out of four (4) physician's reports revealed a diagnosis of dementia. During physical plant tour LPA observed medication closet locked. LPA did not observe medication in the refrigerator located in the kitchen. LPA went through the unlocked door to the laundry room to get to the garage in the garage, LPA observed medication in the extra refrigerator. A second door in the garage leading to the outside side of the facility was unlocked and slightly open making the garage and the medication in the garage refrigerator accessible from the laundry room and the outside. Based on interview conducted, record review and observation the allegation is deemed Substantiated at this time.

Deficiencies cited (Refer to LIC 9099-D). Exit Interview conducted. Copy of Appeal Rights and Report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240705080208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA AMORE
FACILITY NUMBER: 197609345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
CCR
87465(h)(2)
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(h) The following requirements shall apply to medications which are centrally stored:
(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
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Administrator locked door leading to garage and ordered small refrigerator that is able to lock. Administrator provided copy of receipt on todays visit. POC cleared today.
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Based on record review and LPA observation, the licensee did not comply with the section cited above in not properly securing medication making accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
07/19/2024
Section Cited
CCR
87303(f)(4)
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(f) Solid waste shall be stored and disposed of as follows: (4)Movable bins when used for storing... shall have tight-fitting covers on the containers; shall be in good repair; and shall be rodent-proof unless stored in a room or screened enclosure. This requirement is not met as evidenced by:
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Administrator purchased a trash bin with sensors that will open lid automatically. Administrator provided copy of receipt on todays visit. Administrator will submit a picture of trash bins to LPA by POC due date.
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Based LPA observation, the licensee did not comply with the section cited above in not have tight-fitting cover/lid on one(1) trash bin which posed an potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
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