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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191600341
Report Date: 03/07/2024
Date Signed: 03/07/2024 02:24:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/03/2022 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220203143532
FACILITY NAME:HUNTINGTON RETIREMENT HOTELFACILITY NUMBER:
191600341
ADMINISTRATOR:HEATHER ARGUETAFACILITY TYPE:
740
ADDRESS:20920 EARL STREETTELEPHONE:
(310) 370-5828
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:155CENSUS: 101DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Heather Arguent/AdministratorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Resident sustained fracture while in care .
Resident sustained unexplained injuries while in care.
Staff are not following resident's toileting plan.
Staff leave resident's room unsanitary.
INVESTIGATION FINDINGS:
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On 3/7/2024 LPA’s Darneisha Cross and Alfonso Iniguez conducted a subsequent complaint visit to finish a complaint assigned to LPA Montoya on 2/8/22. LPAs Cross and Iniguez met with Heather Argueta /Administrator and explained the purpose of this visit.

Investigation Consisted of: Interview with Administrator(A#1), Facility Staff (S#1-S#9), Residents (R#1-R#10) and Reporting Party (RP). LPA Iniguez reviewed the following records gathered by LPA Montoya: (R#1)’s Admissions Agreement, (R#1)’s schedule of ADL’s, (R#1)’s Service Assessment Forms dated: 5/14/21, 6/12/2021, 7/13/2021 and 1/26/22, copies of staff In-Service Trainings: Infection Control, Disinfection and Covid(2/16/21), Folet Catheter Care (2/24/21 and 3/1/21), Resident Care Feeding(8/19/21), Hands-on Training Proper repositioning and transfer and resident personal care(4/23/21), Wound care(6/22/21), Resident rights-Handwashing Universal Precautions (2/10/20), Copies of (R#1)’s In-Home Communication Notes, Copies of LIC 624 regarding (R#1)’s incidents reports dated( 6/3/21, 7/13/21, 8/16/21, 9/23/21, 10/1/21, 11/12/21, 1/22/22), Copies of (R#1)’ LIC 603-Preplacement Appraisal Information and LIC 602A-Physicians Report for Residential Care Facilities for the Elderly and facility tour.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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 6
Control Number 11-AS-20220203143532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HUNTINGTON RETIREMENT HOTEL
FACILITY NUMBER: 191600341
VISIT DATE: 03/07/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Resident sustained fracture while in care

The details of the complaint alleged that resident sustained fracture while in care at the facility.



During the records review, LPA Iniguez reviewed the Physicians Report for Residential Care Facilities for the Elderly-LIC 602A dated (6/29/21); it is written that (R#1) can care for their own toileting needs. Also, one of the physical Health Statuses of (R#1) was a visual impairment that could have contributed to (R#1)’s falling history. In addition, (1) out of (10) prescribed medications (R#1) were taking could have contributed to their falls; LPA consulted an internet database regarding the side effects of medications, and it is stated that (1) medication’s side effect is “blurred vision, vision change, reduced vision.” Moreover, LPA reviewed (R#1)’s schedule of ADLs, and it is written there that (R#1) needs full assistance getting up in the morning and going to bed, going to the toilet, assistance with dressing, changing briefs for continence care, full assistance with showers on Tuesday, Thursday and Saturday, full escort to their meals, and safety checks every (2) hours.

Moreover, LPA Iniguez observed (R#1)’s Admissions Agreement; it is stated there that (R#1) had between (88-122) Personal Care Points and a total of (4) on Personal Care Level, LPA asked (A#1) what does these points consist, (A#1) stated that on admission day, facility evaluates residents to see what kind of level of care the resident will need, then depending on the level of care points accumulated and at the end a total is added to see what Personal Level of Care is need it to take care of the resident. Then, these instructions are written on an ADL schedule sheet for facility staff to follow.


Evaluation Report continues LIC 9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20220203143532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HUNTINGTON RETIREMENT HOTEL
FACILITY NUMBER: 191600341
VISIT DATE: 03/07/2024
NARRATIVE
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In addition, LPA Iniguez reviewed a Special Incident Report dated (8/16/21). Is it written there that (R#1) was in the bathroom accompanied by their private caregiver when they took a fall in the bathroom? (R#1) had a private caregiver assist them in their room.

During an Interview with the Administrator (A#1), she stated that (R#1)’s family wanted them on a tight schedule set by their family. Also, (A#1) stated that (R#1) did not want to follow that schedule, which caused a problem with their family. (A#1) tried to mediate what the family wished versus what (R#1) wanted.

During interviews with residents (R#1-R#10), (8) out of (10) stated that they did not need assistance going to the bathroom and that they had not sustained a fracture due to not being assisted by facility staff.

During interviews with staff (S#1-S#9), (9) out (9) stated that facility staff assisted (R#1) every time they need it to go to the bathroom and as need it, plus (R#1)’s private caregiver will let them know when they need it to go. Also, (9) out of (9) stated that (R#1) did not sustain fractures due to lack of assistance from staff.

Allegation: Resident sustained unexplained injuries while in care.

The details of the complaint alleged that a resident sustained unexplained injuries while in care at the facility.



During the records review, LPA Iniguez reviewed (R#1)’s medication list dated (4/26/2021). LPA Iniguez consulted an internet database regarding the side effects of medications; LPA found that out of the (10) medicines that were prescribed to (R#1), (4) medications possible side effects could have contributed to the unexplained skin tear and bruising (R#1) experienced. In addition, LPA inspected the Physicians Report for Residential Care Facilities for the Elderly-LIC 602A dated (6/29/21). It is written there that (R#1) did not have a history of skin condition or breakdown. Moreover, LPA reviewed (R#1)’s ADL’s schedule; it is stated that (R#1) “has thin, sensitive skin. Please be very gentle since he bruises easily”.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20220203143532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HUNTINGTON RETIREMENT HOTEL
FACILITY NUMBER: 191600341
VISIT DATE: 03/07/2024
NARRATIVE
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During an Interview with the Administrator (A#1), she stated that they did not sustain unexplained injuries when (R#1) was living at the facility. Also, (A#1) stated that (R#1)’s family usually hired a private caregiver who was with them.

During interviews with residents (R#1-R#10), (8) out of (10) stated that they had not sustained unexplained injuries while living there.

During interviews with staff (S#1-S#9), (9) out (9) stated that (R#1) did not sustain unexplained injuries when they resided here.

Allegation: Staff are not following resident's toileting plan.

The details of the complaint alleged that facility staff did not follow the residents’ toileting plan.



During the records review, LPA Iniguez reviewed the ADL schedule created by the facility upon (R#1)’s admission; it is written there that (R#1) “needs to be toileted when he gets up in the morning, after every meal and before bedtime, assist them on their commode and wheel them over the toilet. Also, let them sit there for a while; otherwise, they say they are done and will not finish”. Additionally, LPA reviewed the Service Assessment Form dated (5/14/21) in the Bathing section; it is written that (R#1) needs complete baths up to three times a week, Bladder Management (R#1) requires continent assistance with physical assistance going to the toilet. This Service Assessment is signed by (R#1) and the responsible party.

During an Interview with the Administrator (A#1), he stated that facility staff assisted (R#1) with their toileting needs, and they used adult diapers but were never left on a soiled diaper for an extended period. Also, (A#1) stated that (R#1)’s family wanted them on a tight toileting schedule set by their family. (A#1) stated that (R#1) did not want to follow that schedule, which caused a problem with their family. (A#1) tried to mediate what the family wished versus what (R#1) wanted.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20220203143532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HUNTINGTON RETIREMENT HOTEL
FACILITY NUMBER: 191600341
VISIT DATE: 03/07/2024
NARRATIVE
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During interviews with residents (R#1-R#10), (7) out of (10) stated that they do not need assistance with toileting. (1) out of (10) stated that they do not need assistance with toileting. Also, (6) out of (10) residents stated that they do not use adult diapers, only (3) out of (10) used them. Out of the (3) residents who used adult diapers, (2) out of (10) stated that they have never been left on a soiled diaper for an extended period.

During interviews with staff (S#1-S#9), (9) out of (9) stated that (R#1) received assistance from facility staff with their toileting needs, and they do not confirm that (R#1) was left in a soiled diaper for an extended time.

Allegation: Staff leave resident's room unsanitary.

The details of the complaint alleged that facility staff leaves resident’s room unsanitary.



During the facility tour, LPAs inspected (8) residents’ rooms, but they did not find the rooms unsanitary.

During an Interview with the Administrator (A#1), she stated that housekeeping cleaned (R#1)’s room every day for light cleaning, every week for deep cleaning, and as needed since (R#1) owned a small dog.

During interviews with residents (R#1-R#10), (8) out of (10) stated that facility staff clean their rooms every day and that their rooms have been safe by them.

During interviews with staff (S#1-S#9), (9) out of (9) stated that (R#1) 's room was cleaned mostly every day and as needed, and (R#1)’s room was never left unsanitary by facility staff.

Evaluation Report continues LIC 9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20220203143532
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HUNTINGTON RETIREMENT HOTEL
FACILITY NUMBER: 191600341
VISIT DATE: 03/07/2024
NARRATIVE
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During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.


California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Heather Argueta /Administrator.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6