191600749-3-29-2024-11-AS-RORN-D3YMRM-20240403095034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 03/28/2024
Date Signed: 03/29/2024 07:07:14 AM

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
03/22/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240322135212

FACILITY NAME:	VILLA SORRENTO		FACILITY NUMBER:	191600749
ADMINISTRATOR:	CARLA CHAN		FACILITY TYPE:	740
ADDRESS:	23450 MADISON		TELEPHONE:	(310) 539-6826
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	145	CENSUS: 107	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	08:17 AM
MET WITH:	Carla Chan		TIME COMPLETED:	05:28 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in a timely manner.

INVESTIGATION FINDINGS:

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On 03/28/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA met with Administrator Carla Chan. LPA explained the purpose of the visit was to investigate the allegation mentioned above.

The investigation consisted of the following: Interviews with administrator #1 (A1), staff #1 -# (S1-S3), residents #1-#10 (R1-R10), and witnesses #1-#5 (W1-W5). Review of the staff and resident rosters, Resident #1 (R1)Admission Agreement, Resident Assessment, Physician's Report, Unusual Incident Reports LIC 624, Identification and Emergency Information LIC 601, and other pertinent documents associated with the complaint. A plant inspection was conducted.

(Evaluation Report continues LIC 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240322135212

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: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 03/28/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not seek medical attention for resident in a timely manner.

The details of the complaint alleged resident #1 (R1) sustained a fall on 03/19/24. The complainant claimed (R1) fell but was fine. (R1) fell again on 3/21/24 and was on the ground for a couple of hours with dried blood. The facility failed to seek prompt medical attention. The complainant reported the owner Maria who refused to call 911 and that companions of (R1) ended up calling for a medic unit.

On 03/22/24, resident #1 (R1) was admitted to Torrance Memorial Medical Center for general weakness according to an Unusual Incident Report LIC 624 (dated: 03/25/24). On 03/20/24, an Unusual Incident Report (dated: 03/25/24) reported (R1) had an unwitnessed fall, and it went unreported. During (R1's) fall, he was on the bed at the foot of the bed. (R1) did not think of informing a staff as (R1) did not feel pain or sustained injury. (R1) claimed to be able to drag self-back to bed with no required assistance.

On 03/28/24 between 09:50 am – 11:10 am, the Department interviewed administrator (A1) and (3) out (3) staff #1-#3 (S1-S3). (A1 and S1) stated they were both made aware of the unwitnessed fall incident that occurred with (R1) and that immediate medical attention was provided. (A1 and S1) claimed that (R1) is not considered a fall risk and did not require 24/7 one-on-one supervision according to (R1's) Physician’s Report (dated: 07/07/22) and Resident Assessment (dated: 11/21/23). (S1) described that in the early hours of 03/20/24, (S2) notified (S1) that (R1) did not want to participate in breakfast as (R1) had fallen during the evening shift and did not report or use (R1’s) call button to alert staff for the incident. (S1-S3) who observed (R1) on 03/20/24, reported that (R1) did not have external injuries or appeared with lacerations, scraps, bruises, or bleeding cuts on (R1’s) body. (S3) claimed to have assisted (R1) before 12:00 pm on 03/20/24 with toileting and grooming and conducted a body check and did not observe any wounds, bruising, or bleeding cuts on (R1). (A1 and S1) confirmed (R1’s) power of attorney and the medical doctor was notified immediately of the incident and that medical assistance was offered, however, refused to be evaluated by (R1’s) primary physician. (S2-S3) stated that (R1) is monitored (4) times a day as indicated on (R1's) Residents Assessment and that all care staff has completed Quarterly In-Service Training on "Unusual Incident Reporting and Protocol" (dated: 12/25/23 and 03/26/24).

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240322135212

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: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 03/28/2024

NARRATIVE

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(A1) disputed the information provided by the complainant is inaccurate. (R1) did not have a second fall on 03/21/24. There was no evidence of dried blood anywhere. There is no owner named Maria. According to (A1), (R1) consumes cranberry juice and has allegedly stained bedsheets with cranberry juice contents that looked similar to blood stains. (A1 and S1) claimed that it was the facility that contacted Emergency Medical Services (Medreach Ambulance Services) on 03/22/24 for (R1’s) emergency service transport. The (EMS) call was requested for (R1's) weakness condition and not for the fall that occurred on 03/20/24. It was clarified that it was not the family companions that made the call to 911.

On 03/28/24 between 11:20 am – 1:37 am, the Department interviewed the power of attorney for (R1) witness #1 (W1) who verified that (S2) had informed (W1) by telephone and text messages of (R1’s) fall on 03/19/24 and (R1’s) refusal to seek medical treatment from (R1’s) primary physician. The communication between (W1) and (S1) can be seen in the text messages provided as evidence by (S1) (dated: 03/20/24). (W1) visited (R1) at the hospital and found no external injuries, such as lacerations, scrapes, bruises, or bleeding cuts on (R1).

On 03/28/24 between 12:45 pm and 12:55 pm, the Department interviewed (R1’s) primary physician’s office staff witness #2 (W2) who verified on 03/20/24 at 10:48 am, (S1) contacted the office to report that (R1) had unwitnessed fall and refused to be medically evaluated by the physician. As a result of the fall and (R1) refused to be medically evaluated, it was recommended that the facility staff monitor (R1’s) condition.

On 03/25/24 between 03:10 pm – 03:24 pm, the Department interviewed hospital social worker witness #3 (W3) from Torrance Memorial Medical Center who verified that (R1) was examined and did not sustain a fracture or any internal or external injuries. (R1) did not have any apparent head injury, lacerations, bruises, or bleeding due to the fall.

On 03/28/24 between 01:30 pm – 02:59 pm, the Department interviewed (9) out of (9) residents #2-#10 (R2-R10) and claimed that facility staff are responsive to provide prompt medical assistance. (R7-R10) reported that staff were immediately able to assist them when they fell at the facility. (R2-R10) all expressed positive attitudes toward staff and had no concerns about their health or safety.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240322135212

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: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 03/28/2024

NARRATIVE

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Residents #1 (R1) and (R1's) companions (W4-W5) were contacted by telephone but did not respond and were unable to provide any information.

Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support NEGLECT/LACK OF CARE Staff did not seek medical attention for resident in a timely manner. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview conducted with Carla Chan and copies of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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