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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 11:21:08 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
06/16/2023 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20230616141521
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 not assisting resident with motorized wheelchair as needed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations 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 not assisting resident with motorized wheelchair as needed. It was alleged Resident 1 (R1) purchased a motorized scooter on their own and asked staff to assist them getting on it, and was told “no, they can’t do that” and they couldn’t use their motorized scooter unless they had a prescription. LPA interviewed Administrator who stated the staff would need training by R1’s nurse or therapist to know how to properly and safely transfer R1 into the scooter. Administrator also stated they know they also require a prescription for a postural support and faxed the doctor for an order.

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-20230616141521
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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LPA interviewed R1 who stated they just wanted to be put from their wheelchair to the motorized chair and why do staff need training and permission from their doctor, “it is my right to be in any chair I want and I should get any and all help I ask for.”

On 6/27/23 LPA received an email from Administrator which included a letter from R1’s doctor stating “(R1) has been a patient in my practice for some time. Upon the review and recommendation of physical therapist, as well as myself, we ALL felt that it was in (R1’s) best interest medically that (R1) NOT have a motorized scooter or wheelchair, as these would impede (R1’s) motivation to improve motor skills on (R1’s) own and get better.” Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of 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