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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801497
Report Date: 03/10/2022
Date Signed: 03/10/2022 04:36:50 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220308131317
FACILITY NAME:AMALIA'S RESIDENCEFACILITY NUMBER:
425801497
ADMINISTRATOR:DEXTER PRICEFACILITY TYPE:
740
ADDRESS:1002 GUNNER STREETTELEPHONE:
(805) 922-5475
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:6CENSUS: 6DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dexter Price, LicenseeTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff took the resident's debit card away.
Staff took the resident's wheelchair away.
Staff do not want the resident to talk on the phone.
Staff will not give the resident the telephone number of the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson and Licensing Program Manager (LPM) Burley conducted an unannounced initial complaint visit to start the investigation. LPA met with Administrator Amalia Ilbian and explained the purpose of the visit. LPA toured the facility. LPA interviewed staff and residents. Licensee Dexter Price arrived shortly and LPA also interviewed him. LPA conducted staff interviews at 9:45am and 10:15 am, resident interview at 10:00am, and a credible witness interview at 2:20pm.
On the allegation: Staff took the resident's debit card away. Resident 1 (R1) stated they did not want to answer questions related to this question. Licensee stated R1 handles their own finances and provides the licensee the monthly fees, and the licensee took them to the bank to withdraw the monthly fees. Due to R1’s diagnosis of schizophrenia, R1 threw themself on the ground in the bank and experienced behaviors. The licensee started taking R1 to the ATM machine instead.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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 2
Control Number 29-AS-20220308131317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMALIA'S RESIDENCE
FACILITY NUMBER: 425801497
VISIT DATE: 03/10/2022
NARRATIVE
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The licensee stated R1 sometimes did not want to go to the ATM machine and wrote the licensee a letter requesting he withdraw money from the bank for him and gave the licensee R1’s debit card and permission to make the withdrawal on their behalf. Licensee stated he gives R1 the debit card back right after, and R1 has a lockbox where R1 can keep valuables locked. The licensee could not provide a record lag to verify these transactions but will in the future. R1 did not state that any money was missing from their account. A credible witness interviewed stated R1 has told them about other issues, but did not state there were any issues with the debit card or money missing. LPA counseled licensee about keeping proper records should they assist any residents in the future.
On the allegation: Staff took the resident's wheelchair. R1 stated they do not use a wheelchair in the facility, and use it sometimes when they go outside. R1 stated they did not want to talk about the wheelchair. R1 later stated that their caregiver assists them with the wheelchair when leaving the facility. The licensee and staff stated R1 uses the wheelchair if he goes out somewhere but does not use it in the facility. Licensee and staff stated R1 can have access to the wheelchair anytime R1 wants it. Based on the information obtained, the allegation is deemed Unsubstantiated.

On the allegation: Staff do not want the resident to talk on the phone. R1 stated they did not want to talk about this. Licensee stated R1 wanted a cell phone through a free cell phone program but could not obtain one. Licensee stated R1 wanted a flip phone so the licensee bought R1 one with the licensee’s own money. R1 confirmed they have a cell phone and have had one for a year. Licensee stated residents have access to the facility phone, but they only have one line for everyone. Licensee stated he bought a Facebook Portal for the facility for residents to share to video chat with family and friends. Credible Witness interviewed stated R1 had their own cell phone and did not believe there were any issues related to R1 talking on the phone. Based on the information obtained, the allegation is deemed Unsubstantiated.
On the allegation: Staff will not give the resident the telephone number of the facility. R1 stated they did not want to talk about this. Licensee and staff stated they have never withheld the facility phone number from residents or staff. Licensee stated the telephone number is posted on the facility bulletin board in the kitchen that all residents have access to. LPA observed the bulletin board and verified the phone number was posted for all residents to access. Based on the information obtained, the allegation is deemed Unsubstantiated.
Exit interview, report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2