191600749-6-19-2024-11-AS-EMAZ-D7BT3D-20240719142211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 06/19/2024
Date Signed: 06/19/2024 03:52:59 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
06/19/2024 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20240619101219

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: 113	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Carla Chan/Administrator		TIME COMPLETED:	03:52 PM

ALLEGATION(S):

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Staff violated residents' personal rights by installing locks on the outside of their doors

INVESTIGATION FINDINGS:

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On 6/19/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Carla Chan /Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Interview with Administrator (A#1), Interviews with Residents (R#1-R#9), Interviews with Facility Staff (S#1-S#5) and Interview with Witness 1 (W#1). LPA gathered the following documentation: Copies of Resident Roster and Staff Roster Copies of (R#1 and R#2) LIC 602 A and Copies if the Emergency and identification form, Copy of SRI dated 6/19/2024, and Complete tour of the facility where LPA checked room # 125 and #264.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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-20240619101219

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: 06/19/2024

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff violated residents' personal rights by installing locks on the outside of their doors

The details of the complaint alleged that facility staff violated resident’s personal rights by installing locks on the outside of their doors.

During the records review, LPA Iniguez observed the SRI created by the facility dated 6/19/24. It is written that on 6/18/24, an Ombudsman representative came to the facility and noticed the locks on the outside of (R#1) and (R#2) doors. (A#1) stated that she explained to the Ombudsman representative that one of the locks was placed by a family member and the other was placed per (R#2) request. Facility staff removed (R#1)’s lock and informed their representative.

During a physical tour of the facility, LPA observed in room #264 a doorknob placed by the facility per the resident's request; since (R#1) is on vacation, they asked the facility administrator (A#1) to place a doorknob lock outside their room. In addition, LPA checked room #125; the lock had been removed by facility staff approximately at 9:00 AM, before LPA arrived at the facility on 6/19/24 approximately at 2:00PM.

During an interview with the administrator (A#1), she stated that regarding the lock on room #125, (R#2) requested that it be placed when they are out of town. (A#1) stated that they have a copy of that key in an emergency. On the other hand, (A#1) stated that the latch lock on room #264 was removed this morning at approximately 9:00 AM prior to LPA's arrival at the facility at 2:00 PM.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240619101219

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: 06/19/2024

NARRATIVE

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During an interview with Resident 1 (R#1), they stated that she is currently out of the facility taking vacations. (R#1) indicated that they requested to put a lock on the outside of their room while they are gone. In addition, (R#1) stated that facility staff has the key for that lock. In addition, (R#1) stated that the facility staff has never violated their personal rights.

During an interview with Resident 2 (R#2), they stated that they asked their son (W#1) to place that lock outside their room because they were relieved when (R#2) left the facility. (R#2) was upset because facility staff removed the lock this morning. In addition, (R#1) stated that the facility staff has never violated their personal rights.

During interviews with residents (R#3-R#9), (7) out of (9) residents stated that the facility has never put a lock on their door and no facility staff has ever violated their rights.

During interviews with staff (S#1-S#5), (5) out (5) facility staff stated that the facility has never placed a lock on a resident’s door without their knowledge and has never violated the rights of the residents in care.

During interviews with Witness #1 (W#1), they stated that they put the lock outside of (R#2) per their request. (W#1) stated that they did not notify the facility. In addition, (W#1) stated that (A#1) called them this morning to inform them that the lock had been removed today 6/19/24.

During this investigation, LPA found did not find sufficient evident 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.

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

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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