191600749-2-2-2024-11-AS-EMAZ-D8QU83-20240902152051

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 02/02/2024
Date Signed: 02/02/2024 04:34:25 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20231214112553

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:	02/02/2024
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Carla Chan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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The facility does not provide comfortable room temperatures.

The facility staff does not have the ability to communicate with residents

The facility does not make menu available for review by the residents.

INVESTIGATION FINDINGS:

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On 02/02/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility listed above. LPA met with Executive Director, Carla Chan, and the purpose of today's visit was explained.
During today's visit, LPA toured the facility, interviewed Staff (S3-S8) and received and reviwed housekeeping laundry schedule, additional resident MARs, and AC Unit rooms.

On a 12/21/23, LPA toured the facility, interviewed Staff (S1 and S2) and Residents (R2-R10) and reviewed and received copies of pertinent documents pertaining to the investigations. The documents reviewed and received include a Staff Roster (LIC500), Resident Roster, Weekly Dining Menu, Physician’s Report, Needs and Service Plan, Centrally Stored Medications, Medication Administration Record (MAR), Appraisal, Identification and Emergency Information, and Admission Agreement.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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-20231214112553

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: The facility does not provide comfortable room temperatures.
The allegation alleges when resident turns the temperature up staff ask them to turn it down because other residents are hot resulting in the resident being cold.

During an interview with Staff S1 stated rooms do not have their own heater or AC and that 5 to 6 rooms are controlled by one thermostat in a resident’s room. During the tour of the facility, LPA checked the temperature of thermostats in common areas. LPA observed the following thermostats and their settings set at: activity room 73-degrees, lobby 76-degrees, sitting lounge 74-degrees, music room 73-degree, dining room 72-degrees, upstairs activity room and lounge was set at 73-degrees Fahrenheit. Additionally, during the facility tour LPA inspected rooms that housed the thermostat controls and observed the following in room 128 the temperature was set at 72- degrees, in room 107 the temperature was set at 74-degrees, in room 251 the temperature was set at 76-degrees and in room 217- the temperature was set at 76-degrees Fahrenheit. During interviews with R1, they stated they have the thermostat controls in their room, and it is connected to other rooms. R1 states when they are cold, they turn the heat up and staff come in an ask to turn it down due to the other residents being hot, resulting in R1 being cold. During the tour LPA observed the thermostat connected to their room was set at 76-degrees Fahrenheit. During interviews with Residents (R1-R10) five (5) out of ten (10) stated the facility is kept at a comfortable temperature, two (2) residents stated it is sometimes warm, one (1) resident stated it is sometimes cold at night, and two (2) stated it sometimes too warm then other

Continued on LIC9099

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231214112553

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 02/02/2024

NARRATIVE

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residents open their slider and a cold breeze comes in. During interviews with Staff (S1-S8), eight (8) out of eight (8) stated the temperature is maintained at a comfortable temperature. During visits at the facility, LPA observed the temperature to be comfortable in the facility.
During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated.

Allegation: The facility staff does not have the ability to communicate with residents.

The allegation alleges staff do not speak English well enough for Resident to understand.

During interviews with Residents (R1-R10), nine (9) out of ten (10) stated they have no concerns regarding staff’s ability to communicate with residents. During interviews with Staff (S1-S8) eight (8) out of eight (8) stated they do not have any issues communicating with residents and are able to understand residents needs and concerns. During LPA’s visit to the facility, LPA observed residents and staff communicating without issues. Residents were observed expressing their needs or concerns to staff and they were receiving assistance they requested. LPA observed breakfast and lunch being served at the facility. LPA observed kitchen staff communicating with residents regarding the menu and any special requests

Continued on LIC9099

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231214112553

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 02/02/2024

NARRATIVE

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residents had. LPA did not observe any issues with communication between staff and residents.
During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated.

Allegation: The facility does not make menu available for review by the residents.

The allegation alleges staff does not provide a food menu to Resident.

During the tours of the facility, LPA observed the weekly meal menu posted at the front and rear entrance of the dining room. Additionally, when LPA asked S7 for a copy of the menu they opened a drawer in the front desk and pulled out copies and provided LPA with a copy. During interviews with Residents (R1-R10) nine (9) out of ten (10) stated the weekly menu is posted near the front and rear entrance of the dining room and menus are provided to residents by staff and available anytime at the front desk. During interviews with Staff (S1-S8), eight (8) out of eight (8) stated the facility menu is posted at the front and rear entrance of the dining room and menus are provided to residents who want one.

During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231214112553

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 02/02/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	During today's visit LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Carla Chan, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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