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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801497
Report Date: 07/31/2023
Date Signed: 07/31/2023 11:22:57 AM

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
06/19/2023 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20230619100031
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:
07/31/2023
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Dexter Price, AdministratorTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Staff violated residents personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA conducted the 10 day visit and requested relevant documents on 6/19/23. LPA Olson interviewed reporting party and Administrator on 6/19/23. LPA Olson met with Dexter Price, Administrator and explained the purpose of the visit.

On the allegation: Staff violated residents personal rights. It was alleged that Resident 1 (R1) was being mistreated because they were rudely told they would have to leave and go somewhere else. LPA interviewed R1 who stated staff said R1 would be evicted if they didn’t follow the rules. LPA interviewed Administrator who said that R1 is very private and refuses to communicate with staff when there is an issue and won’t allow anyone to speak to the doctor or home health nurse to ensure the facility can properly care for R1. R1 confirmed that they refused to allow the facility to communicate with their doctor or home health nurse and have rights under HIPPA and will sue anyone who violates their HIPPA rights.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
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-20230619100031
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: 07/31/2023
NARRATIVE
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R1 stated “It’s no one’s business what is going on with me.” The facility would be unable to meet R1’s needs if they are not allowed to know what the needs are, and not being able to meet a resident’s needs is a valid reason for eviction. LPA asked about the tone that staff stated they would have to go and R1 said no staff did not have a rude tone but it sounded like a threat. R1 promised to be more cooperative and allow nurses and doctor’s to communicate relevant information in order to be able to provide care because they wanted to stay at the facility. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of the report issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2