<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600256
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:20:40 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220909155151
FACILITY NAME:HOME SWEET HOMEFACILITY NUMBER:
198600256
ADMINISTRATOR:CODRUTA PAULA VALEANUFACILITY TYPE:
740
ADDRESS:3342 COLD PLAINS DR.TELEPHONE:
(626) 333-4917
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:5CENSUS: 3DATE:
09/14/2022
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Codruta Valeanu TIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not following Covid-19 protocol.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Christine Wong conducted an initial 10 days investigation to address the above allegation. LPA met with administrator/licensee Codruta Valeanu and explained the reason of the visit.

The investigation consisted of the following: LPA interviewed the administrator, three residents (R1-R3) and reviewed residents files.

The investigation revealed of the following: In regards to the allegation "Facility not following Covid-19 protocol." LPA interviewed residents and all reported they do not wear mask in the facility as this is their home and they do not need to wear mask. And for the administrator, she does not need to wear mask too as she is the live in staff and she is like their family memebrs. Residents reported all the visitors would wear mask while in the facility and facility does follow the Covid-19 protocol and they all feel comfortable and safe living here. (See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
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 28-AS-20220909155151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HOME SWEET HOME
FACILITY NUMBER: 198600256
VISIT DATE: 09/14/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administrator also reported that she lives in the home with the residents and they are all like family members, therefore she does not wear mask in the facility. For all visitors, they are all required to have face covering in the facility even they are fully vaccinated. However, when LPA arrived the facility, there's no sign in policy to ensure compliance with entry point for symptom screening and to record contact information. Administrator admitted she did not do it because most of the visitors are the immediate family members for the residents.

Based on LPA observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8 are being cited on the attached LIC9099D)

Exit interview conducted with Administrator Codrute Valeanu and a copy of this report is being provided. In addition Appeal Rights were given.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220909155151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HOME SWEET HOME
FACILITY NUMBER: 198600256
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/22/2022
Section Cited
CCR
87470(c)(1)(F)
1
2
3
4
5
6
7
87470 Infection Control Requirements (c)(c) An Infection Control Plan shall be ....shall be included in the Plan of Operation required by Section 87208.(1)(1) The Infection Control Plan shall include all of the following:(F)Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance
1
2
3
4
5
6
7
The administrator will ensure to follow the infection control plan. The administrator will put the visitors sign in log book by the front door and start checking temperature and symptoms upon entering the facility. The administrator will send the picture to LPA by POC due date.
8
9
10
11
12
13
14
The requirement is not met as evidenced by: LPA's observation. LPA observed there was no sign in policy to ensure compliance with entry point for symptom screening and to record contact information which posed a potential risk for residents in care.
8
9
10
11
12
13
14
*POC was cleared during the time of the visit."
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3