374604611-9-19-2023-08-AS-LTEZ-CW5SS8-20230929140730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604611
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:29:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2023 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20230615114256

FACILITY NAME:	IDEAL HOME CARE		FACILITY NUMBER:	374604611
ADMINISTRATOR:	HULSEY, JOSEFINA I.		FACILITY TYPE:	740
ADDRESS:	3337 STOCKMAN STREET		TELEPHONE:	(619) 272-2663
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY:	6	CENSUS: 4	DATE:	09/19/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Facility Manager Ben Rosario		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not treat resident with dignity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow-up and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Facility Manager Ben Rosario.

During today's visit, LPA observed residents in care and interviewed staff.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not treat resident with dignity, specifically, that the Licensee punched Resident 1 (R1). Review of medical records revealed that R1 did not have memory impairment, not confused or disoriented, was able to follow directions and make needs known.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 08-AS-20230615114256

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IDEAL HOME CARE	FACILITY NUMBER: 374604611
	VISIT DATE: 09/19/2023

NARRATIVE

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Interviews with the staff and Licensee revealed that facility staff were responsible for assisting residents with activities of daily living (ADLs), preparing meals, maintaining the cleanliness of the facility, and passing medications. Interviews and LPA observation revealed that residents called for assistance by using bells or verbally called for staff. Interviews and assessment records revealed that R1 had a history of agitation and unpleasant and rude behaviors when interacting with others. Interviews revealed that R1 called the police twice regarding verbal disagreements between R1 and the facility, in which R1 was yelling at staff. No arrests were made at either police visit. Interviews revealed that the two police calls were not made in response to the alleged incident between R1 and the staff. Interviews with residents and outside sources did not reveal any issues with the care provided by staff and described facility staff as very responsive to resident care needs as well as communication with family members. Interviews with residents, staff, and outside sources denied hearing any raised voices, yelling, screaming, or rude words. Interviews with staff and the Licensee did not reveal any evidence of the Licensee or staff hitting, slapping, punching, or physically abusing residents. Interviews stated that R1 did not have any injuries, marks, or bruising related to the alleged incident.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Facility Manager Ben Rosario, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

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