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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801823
Report Date: 10/20/2022
Date Signed: 10/20/2022 04:00:07 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
11/29/2021 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20211129103051
FACILITY NAME:AMALIA'S RESIDENCE IIFACILITY NUMBER:
425801823
ADMINISTRATOR:DEXTER PRICEFACILITY TYPE:
740
ADDRESS:1206 KENSINGTON AVENUETELEPHONE:
(805) 287-9630
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 6DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Dexter Price, Administrator/LicenseeTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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9
Staff hit resident in care.
Staff handled resident in a rough manner while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for this investigation. LPA met with Dexter Price, Administrator/Licensee and explained the purpose of the visit. LPA reviewed documents and interviewed Hospice Nurse on 10/14/2022, R1’s family member on 5/27/2022, and staff on 10/14/2022.

On the allegations: Staff hit resident in care and Staff handled resident in a rough manner while in care. It was alleged that Resident 1 R1 informed their Hospice Nurse that a male staff member was hitting R1 and told R1 no, and put their hand over R1’s mouth so R1 couldn’t talk and had difficulty breathing. LPA Olson interviewed R1’s Hospice Nurse. The Hospice Nurse stated that they have no suspicions of abuse and the resident showed no physical signs of abuse at that time. The nurse stated that there was only one male staff at the home and that was the owner/Administrator but the resident also had many hallucinations and didn’t indicate if it was the Administrator or if it was someone R1 hallucinated.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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-20211129103051
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/20/2022
NARRATIVE
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The Hospice nurse also stated the Administrator did not give direct care to patients so it would be very strange if the allegation was against them. The hospice nurse confirmed R1 would talk to people and mention people who weren’t present in the room and they were actively working with the Administrator to help R1 with their extreme hallucinations. LPA asked if the Hospice Nurse had any suspicions of abuse from the Administrator or any staff and the Hospice nurse stated “No, I have zero suspicion of any abuse.” LPA interviewed Administrator who stated they never put hands on the resident. LPA interviewed staff who stated the Administrator had never hit or put a hand over a resident’s mouth and doesn’t provide direct patient care. Based on interviews the allegations are deemed Unsubstantiated at this time.

Exit interview conducted, copy of report emailed to Administrator/Licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2