191600749-8-17-2024-11-AS-EMAZ-D8QU82-20240902152049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 08/17/2024
Date Signed: 08/17/2024 02:44:23 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
12/14/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

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: 113	DATE:	08/17/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Jovan Caday		TIME COMPLETED:	09:46 AM

ALLEGATION(S):

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The facility did not safeguard resident's personal property.
The facility does not to give medication according to the physician's directions.
The facility does not provide comfortable living accommodations for the resident.

INVESTIGATION FINDINGS:

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On 08/17/24, Licensing Program Analyst (LPA) Ernand Dabuet, conducted an unannounced visit to deliver findings for the allegations listed above. LPA Dabuet met with the facility's managerJovan Caday and explained the purpose of today’s visit.

Investigation consisted of the following: During a visit on 02/02/24, LPA Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility. LPA met with Executive Director, Carla Chan, and the purpose of the visit was explained. During the visit, LPA toured the facility, interviewed Staff (S3). During a visit 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.
(Evaluation Report continues LIC 9099-C)

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: 08/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2024

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 3

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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 08/17/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: The facility did not safeguard resident's personal property.

The allegation alleges not all residents’ clothes are returned after laundry and staff place tight socks on their feet and male t-shirts.

During an interview with R1, they stated they have had items go missing during laundry such as compression socks, shirts, and pants. R1 stated they have been put in male t-shirts which was not theirs. During interviews with Staff (S1-S7) seven out of seven (7) stated it has been a while since they have had a resident report an item missing. During interviews with staff (S1-S4) four (4) out of four (4) stated that if a resident is missing an item after laundry, staff will check with housekeeping to see if the item was left in the laundry room and if it is not there then they go help look in the resident’s room for the item. If the item is not located, they check the rooms of the other residents whose laundry was also done that day. During interviews with Staff (S3 and S4) stated each residents laundry is done separately to help minimize clothing mix-ups. LPA received and reviewed a copy of the facility’s laundry schedule. During interviews with Residents (R1-R10) two (2) out of ten (2) stated they have had items go missing.

During file review, LPA received and reviewed a copy of R1’s Safeguard for Valuables and Property, which does not list any personal items on it.

Allegation: The facility does not give medication according to physician’s directions.

The allegation alleges staff messes up Resident medication and would like to administer their own medication.

During an interview with R1 stated staff bring their medications in early and they do not want to get up that early. R1 stated they want to administer their own medications. During file review, LPA observed on R1’s Physician’s Report the physician stated, “All meds need to be administered and stored for patient.” LPA reviewed resident R1’s MAR, and observed that for the months of September, October, and November medications were administered according to the medication prescription. Additionally, during the facility visit, LPA reviewed the medication and Medication Administration Record (MAR) for ten (10) residents.

(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: 08/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2024

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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 08/17/2024

NARRATIVE

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LPA observed ten (10) out of ten (10) resident’s MARs and medication are consistent with properly documented records.

During interviews with Residents (R1-R10), were asked if they receive their medications as prescribed, seven (7) out of ten (10) stated they receive their medications as prescribed, and two (2) of the ten (10) do not receive assistance from staff administering their medications.

During interviews with Staff S1-S7, were asked if residents receive their medications as prescribed, seven (7) out of seven (7) stated if the facility is managing their medications, they are provided according to the prescription label.

Allegation: The facility does not provide comfortable living accommodations for the resident.

The allegation alleges due to the size of their room they either eat on their commode or go downstairs to the dining room.

During the interview with Residents R1-R10, were asked if the facility provided comfortable living accommodations for residents, nine (9) out of nine (9) stated they are provided with comfortable accommodations.

During interviews with Staff S1-S8, were asked if residents are provided with comfortable living accommodations, eight (8) out of eight (8) stated residents are provided with comfortable accommodations.

During the facility tour, LPA inspected R1’s room and observed it had the required furniture and there is open space available in the room. The bathroom door was wide enough to allow a wheelchair to fit. LPA observed ample space.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Jovan Caday, and a copy 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: 08/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2024

LIC9099 (FAS) - (06/04)

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