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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881471
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:09:22 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2024 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20240918161101
FACILITY NAME:BELLAHOMECARE IIFACILITY NUMBER:
371881471
ADMINISTRATOR:COOK, CHERRYFACILITY TYPE:
740
ADDRESS:884 GRETNA GREEN WAYTELEPHONE:
(760) 975-3751
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 4DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Caregiver, Arden Valdobino TIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff neglected resident while in care
Staff do not provide a safe and healthful environment
Staff do not provide assistance with dressing and grooming
INVESTIGATION FINDINGS:
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Licensing Program Analyst, (LPA) Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Cherry Cook over the phone and Caregiver, Arden Valdobino, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews with staff members and residents, and a review of records.
On September 18, 2024, Community Care Licensing received a complaint alleging that staff neglected resident while in care, staff do not provide a safe and healthful environment, and staff do not provide assistance with dressing and grooming. It was reported that when R1 calls for staff, staff do not come to assist R1. LPA interviewed Administrator who stated that the residents all have a call light button to request for assistance and staff are available to assist.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 18-AS-20240918161101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLAHOMECARE II
FACILITY NUMBER: 371881471
VISIT DATE: 12/12/2024
NARRATIVE
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Administrator also stated that the facility does laundry daily for R1. Administrator admitted that R1 did wear the same clothes twice in one week, but indicated the clothes were washed. LPA conducted interviews with staff members, who indicated they do assist R1 with grooming, dressing, and laundering. Information obtained from interview with R1 stated that they provide assistance in showers twice a week, grooming and dressing daily. Information obtained from interviews with additional pertinent parties corroborated the information provided. During the facility tour, LPA observed clean clothes in R1’s closet and dressers and LPA reviewed shower logs for residents. LPA requested and obtained shower logs for the past two months. No concerns were observed.

Based on the information obtained during the investigation, this agency has investigated the complaint that staff neglected resident while in care, staff do not provide a safe and healthful environment, and staff do not provide assistance with dressing and grooming. We have found that the complaint was unfounded, meaning that the allegations are false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Cherry Cook over the phone and signed by Caregiver, Arden Valdobino.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20240918161101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLAHOMECARE II
FACILITY NUMBER: 371881471
VISIT DATE: 12/12/2024
NARRATIVE
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Administrator indicated the facility is well staffed and there are no concerns regarding the level of care being provided. Information obtained from staff members stated that they attend to the resident in a reasonable amount of time when they are called. Information obtained from interview with R1 stated that the staff members take a while but did not provide a specific a time frame. LPA interviewed additional pertinent parties, who revealed that there was no issue in regards to waiting for an unreasonable time for assistance. During the LPA’s visit, the LPA verified that R1’s call light was operational.

It was also alleged that facility staff were not providing a safe and healthful environment. It was alleged that there was a snake in R1’s room. Administrator stated the facility does not have any animals at the facility. Administrator denied observing or being notified about a snake in R1’s room. Administrator also denied that the facility has an issue with reptiles. Information obtained from an interview with R1 stated R1 saw a long, skinny object moving in the corner of the room. During tour of the facility, LPA observed the facility inside and out, and did not observe a snake. Information obtained from interviews with additional witnesses revealed no issues or concerns regarding snakes in the facility.

In regards to the allegation that staff do not provide assistance with dressing and grooming, it was reported that the facility did not shower or groom R1. It was reported that R1 was sent to an outing in the same clothes that R1 wore earlier in the week. Administrator stated that the facility has shower logs and the facility provides assistance with daily grooming and dressing.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3