191600749-11-1-2021-11-AS-JHAD-C8KSPU-20211108130341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 09/21/2021
Date Signed: 11/01/2021 03:22:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/16/2021 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210916154455

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: 76	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Carla Chan		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff is spraying a resident with an unknown chemical
Resident's mail is being mishandled while in care

INVESTIGATION FINDINGS:

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On 9/21/21 Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent complaint investigation for the above listed allegations. LPA met with Jovan Caday, the facility supervisor and the purpose of the visit was explained. The supervisor contacted the administrator Carla Chan by phone and LPA was later met by administrator.

During today’s visit, LPA Brown requested and obtained copies of the following documents staff and client roster, resident R1’s Admission Agreement, Emergency contacts, most recent physician reports/Appraisal and needs and service, incident reports related to the above allegations. LPA reviewed staff #1-3 training records. LPA toured the facility with the administrator. LPA did not interview resident #1 due to not being at the facility. LPA attempted to reach by telephone but was no answer. LPA conducted interviews with Residents #2-8, staff #1-4 and administrator.

The investigation revealed the following: Interviews and records review.

Regarding allegation #1: Staff is spraying a resident with an unknown chemical.
LIC 9099-C is on the next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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-20210916154455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 09/21/2021

NARRATIVE

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On 9/21/21, LPA interview residents #2-8 regarding the above allegation. Residents stated they have not been sprayed by staff with chemicals. Residents stated they have no problems with staff. Residents stated, R1 told them staff was spraying chemicals and was going to killed. LPA interview the administrator, she stated only R1 has told her staff had sprayed chemicals coming from the sprinklers and vents. R1 also told her was going to be killed by staff. She stated had went to R1’s room and did not see any traces of chemicals. She stated R1 is never really at the facility and is independent. She stated R1 has a car and mainly sleeps in there. LPA interview Staff #1-4, they stated R1 told them was being sprayed with chemicals and someone is trying to kill R1. They stated the resident doesn’t really stay at the facility and has not been seen.

Regarding allegation #2 Resident's mail is being mishandled while in care.

On 9/21/21, LPA interview residents #2-8 regarding the above. Residents stated their mail is located in the mailroom on the first floor. They stated they are able to get their mail and do not have a problem with receiving it. They also stated large package mail is brought to their rooms. LPA interviewed the Administrator and she stated residents are able to get their mail from the mailroom. She stated has not heard of any residents having problems receiving mail. LPA interviewed staff #1-3 stated they haven’t heard anyone not receiving their mail. Staff #4 stated they distribute all resident mail and put into the mail slot, but some of the resident’s family prefer mail to stay in the office and the residents will come and get them. LPA was able to look inside mail room, which was located on the first floor and did not see any concerns with mail.

Based on interviews conducted and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Carla Chan, Administrator and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

LIC9099 (FAS) - (06/04)

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