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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609661
Report Date: 04/07/2022
Date Signed: 04/07/2022 04:26:18 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,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2021 and conducted by Evaluator Kelly Dulek
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20210823121422
FACILITY NAME:BERNADETTE HOME CARE 1FACILITY NUMBER:
567609661
ADMINISTRATOR:ABIERA, BERNADETTEFACILITY TYPE:
740
ADDRESS:510 MARISSA LNTELEPHONE:
(818) 601-9089
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 6DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Bernadette AbieraTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Licensee is not serving a good quality of food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint visit to the above noted facility. The purpose of the visit is to conclude an investigation regarding the above allegation initiated on 08/31/2021. LPA initially met with staff Jo Almazan and explained the reason for the visit. Licensee Bernadette Abiera arrived at 4:17PM. Entrance Interview conducted.

On 08/23/2021, the Department received a complaint which alleged the facility did is not serving a good quality of food. On 08/31/2021, LPA Dulek conducted an initial complaint inspection from 10:11AM to 12:55PM. During the initial complaint visit, LPA Dulek conducted a facility tour with Licensee Bernadette Abiera at 10:25 AM, staff interviews between 10:34AM and 11:00AM, interviewed residents between 11:11AM and 11:24AM and gathered copies of documents pertinent to the investigation. During today’s visit, the LPA along with Licensee toured the facility at 4:18PM. The following was concluded:

(Report continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME:
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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-20210823121422
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: BERNADETTE HOME CARE 1
FACILITY NUMBER: 567609661
VISIT DATE: 04/07/2022
NARRATIVE
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(Continued from LIC 9099)

Resident interviews revealed that 3 of 3 residents interviewed are happy with the food; “food is good, if you ask for something, they get it the next day.” The licensee does the shopping for the facility and delivers the food to the facility. Staff prepare the meals daily for the residents. LPA observed a variety of foods in the refrigerator, freezer and pantry during both visits at the facility. During the course of the investigation, LPA Dulek communicated with pertinent parties in order to obtain additional information. Emails were exchanged on the following dates: 08/26/2021 LPA sent an email, response was received 09/24/2021, again LPA reached out on 10/28/2021 and 11/30/2021. Reply was received on 12/06/2021 indicating additional evidence to support the allegations would be sent, LPA replied on 12/07/2021. On 12/19/2021, LPA received an email indicating additional information would be delivered to LPA in person, however no date was set. LPA reached out again via email on 03/15/2022 and has yet to receive a response. Therefore, although the allegation may be true or is valid, at this time there is insufficient evidence to support the allegation, therefore the above allegation “Licensee is not serving a good quality of food” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided by email.
SUPERVISORS NAME:
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2