191600749-8-17-2023-11-AS-JHAD-CV9578-20230831194152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 08/17/2023
Date Signed: 08/17/2023 05:27:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/11/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230811162618

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: 116	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Trish Morales		TIME COMPLETED:	01:47 PM

ALLEGATION(S):

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Staff does not provide a safe and healthful environment for resident while in care.

INVESTIGATION FINDINGS:

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On 08/17/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA met with assistant administrator Trish Morales. LPA explained the purpose of the visit is to investigate the allegation mentioned above.

Investigation consisted of the following: Interviews with staff #1 -#4 (S1-S4) and residents #1-#10 (R1-R10), a review of resident #1 (R1's) Admission Agreement, Appraisal/Needs and Service Plan, Physician's Report, Incident reports and other pertinent documents associated with the complaint. A review of staff and resident roster and plant inspecton of the entire faciltiy along with room #247.

Evaluation Report continues LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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-20230811162618

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VILLA SORRENTO	FACILITY NUMBER: 191600749
	VISIT DATE: 08/17/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff does not provide a safe and healthful environment for resident while in care.
The details of the complaint alleged that staff is not providing a safe and healthful environment for resident #1 (R1). The complainant reported that staff #1 (S1) is allowing staff to spray chemicals under (R1's) room which causes (R1) to have side effects with red eyes and headaches. The Department reached out to the complainant who was not available for further statements on the matter.

The Department inspected resident #1 (R1's) room #247 who was not in the facility and unavailable for an interview. The Department did not detect a smell of any chemical or toxic substances in room #247 nor adjacent rooms in #244, #246, and #249. The hallways did not emit a smell of disinfectants, pesticides, paint, or other hazardous chemicals. Interviews with residents #2 - #8 (R2-R8) were all complimentary of staff and reported that management provided a safe and healthful environment for all residents. (R5-R8) stated having pest control sprayed in their rooms and did not feel discomfort or had side effects from the chemicals used. The Department inquired about the pest control service utilized by the facility and was informed by office manager witness #1 (W1) the three active ingredients used are all approved by Environmental Protection Agency (EPA) and are safe for humans and pets. Interviews with (S1-S4) all verified that no types of chemical spraying took place for (R1's) room #247. (S1-S4) stated that (R1) is independent and is active in the community daily and it is only at the facility at night. (S1) reported that this has been a recurring matter for (R1) in the past and no evidence that the staff is not providing safe and healthful accommodations for (R1). (S3) verified who is responsible for cleaning (R1's) room regularly with soap and water and no harsh cleaning chemicals are used. There were no interviews available for residents #1, #9, and #10 (R1, R9-R10) during this investigation. The Department investigated the same allegation complaint #11-AS-20230601120242 on 06/01/23 and determined no evidence to support the allegation, and was determined unsubstantiated.

Based on the information gathered, an inspection of the facility, observation, and interviews conducted, documents reviewed, the Department found no evidence to support the allegation mentioned above.

Although the allegation may have happened or is 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 was conducted with Trish Morales and a copy of the report was provided.
This report serves as an amendment to clarify finding on line #24 & #22. It does not supersedes the complaint investigation findings reflected on report created 08/17/23.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC9099 (FAS) - (06/04)

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