198603655-2-6-2025-28-AS-DSIS-DE4VE7-20250221152148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603655
Report Date: 02/04/2025
Date Signed: 02/06/2025 10:39:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
01/30/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250130145315

FACILITY NAME:	ALTA VISTA CARE HOME		FACILITY NUMBER:	198603655
ADMINISTRATOR:	ENRIQUEZ,ALMA/STINSON,NICO		FACILITY TYPE:	740
ADDRESS:	5349 N. OAKBANK AVE.		TELEPHONE:	(626) 587-0088
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	6	CENSUS: 6	DATE:	02/04/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alma Enriquez, LIcensee		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff lock the facility door not allowing resident access into the facility.
Staff do not provide adequate meals to residents.
Staff are not ensuring resident is bathed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted a unannounced complaint investigation for the allegations listed above today. LPA met Licensee, Alma Enriquez and explained the purpose of today's visit.

The investigation consisted of the following: LPA reviewed and requested copies of Resident #1 (R1) to Resident #3 (R3) file documents such as Identification and Emergency Information, Physician’s Report, and Admission Agreement. LPA also requested Staff and Resident Roster. LPA also interviewed Resident #1 (R1), Resident #3 to Resident # 5 (R5), Licensee, and Staff #1 (S1) to Staff #2 (S2). LPA attempted but unable to interview Resident#2 (R2) and Resident #6 (R6) as R2 and R6 did not answer questions due to medical conditions on the date of the visit.

[Continued in LIC-9099-C]

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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 28-AS-20250130145315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALTA VISTA CARE HOME	FACILITY NUMBER: 198603655
	VISIT DATE: 02/04/2025

NARRATIVE

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Allegation: Staff lock the facility door not allowing resident access into the facility. It is alleged that on 1/24/2025 at 4:15 PM, R1 sitting outside in the porch area, commented that the front door was locked and that nobody was answering the door when R1 rang the doorbell. It was reported that the staff didn’t answer the door for approximately 7 minutes. All staff interviewed denied the allegation. Four (4) out of four (4) residents interviewed denied the allegation. Based on interview, R1 stated on not being locked out of the facility when asked if R1 was locked out on 1/24/2025. R1 did indicate that the only time the facility locks the door is when R1 has family or friends, R1 would lock his bedroom door to have more privacy. R1 did not indicate ever being locked out nor not being granted access to the facility. Based on interview, the Licensee stated that the front door is locked since there are residents that have Dementia and are a wandering risk. However, the staff are with residents when they go out to the porch and backyard. Based on observation, the facility has a loud doorbell and sensor that has a loud sound when the door opens and closes. There is not enough evidence to substantiate.

Allegation: Staff do not provide adequate meals to residents. It is alleged that residents are served soup every time which is made by combining different canned foods, e.g., canned broth, vegetables, and beans. It is also reported that dinner is always canned soup and sometimes staff add meat to the canned soup and a variety of food is not served to residents. All staff interviewed denied the allegation. Four (4) out of four (4) residents interviewed denied the allegation. LPA observed that the facility provides sufficient 2-day perishable and 7-day non-perishable foods. LPA also observed facility had sufficient supply of fresh vegetables, fruit, flour, and condiments. Based on staff interviews, facility provides alternative options from residents’ requests such as R3 recently requested to eat soup which the facility provided. When another residents like what the other resident is eating, they would request to eat the same meal. LPA also observed that the facility was cooking beef patty, mashed potatoes, and mixed vegetables for lunch on the day of the visit. LPA observed residents eating lunch on the day of the visit. There is not enough evidence to substantiate.

[Continued in LIC-9099-C]

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250130145315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALTA VISTA CARE HOME	FACILITY NUMBER: 198603655
	VISIT DATE: 02/04/2025

NARRATIVE

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Allegation: Staff are not ensuring resident is bathed. It is alleged that R2 goes an entire week without being bathed and R2 is unable to bathe himself. All staff interviewed denied the allegation. Four (4) out of four (4) residents denied the allegation and all stated they do not know if staff provide bathing assistance to R2. LPA attempted to interview R2 but was R2 unable to answer the questions due to medical conditions. Pre physician’s report dated 03/07/2024, it indicated that R2 needs assistance with showering/bathing. Licensee and S1 both stated that R2 bathes 2 to 3 times per week and the staff provides bathing assistance by giving instructions, directions, and verbal coaching which R2 is able to follow. Based on observation, R2 was clean and had no odor. R2 also has sufficient hygiene supplies. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held with the Licensee, Alma Enriquez and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC9099 (FAS) - (06/04)

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