191600749-6-8-2023-11-AS-MVAO-CXKUYK-20231114150003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600749
Report Date: 06/06/2023
Date Signed: 06/08/2023 02:54:55 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
06/01/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230601120242

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: 115	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Carla Chan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff speak inappropriately to resident
Staff sprayed an unknown chemical into resident's room
Staff stole resident's belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, June 06, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Administrator Carla Chan

The investigation consisted of the following: Interviews conducted with staff 1- 3 (S1-S3) and residents 1-11 (R1-R11). LPA Bunker asked questions relevant to the nature of the complaint. During today’s visit, LPA Bunker requested and obtained copies of the following documents staff and residents roster, resident R1’s Admission Agreement, Emergency contacts, most recent physician reports/appraisal and needs and service, and incident reports related to the above allegations. LPA toured the facility with the Administrator Carla. LPA was unable to interview R1 due to not being at the facility. LPA attempted to reach R1 via telephone several times, but there was no answer.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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-20230601120242

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: 06/06/2023

NARRATIVE

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Continued LIC9099-C page 2
***This amended LIC9099-C superseded the original LIC9099-C dated 06/06/2023.***
Allegation 1: Staff speak inappropriately to resident
Staff 1-3 (S1-S3) and residents 1-11 (R1-R11) stated staff does not speak inappropriately to residents. R2-R11 stated staff treats residents with dignity and respect. R2-R11 stated that their daily care needs are being met and they were happy living here and had no problems with the staff. S1-S3 stated staff communicates with residents professionally and respectfully, refraining from any inappropriate behavior or language. S1 stated staff prioritizes treating all residents with dignity and courtesy. Resident 1 (R1) stated staff members speak inappropriately to residents. S1-S3 and R2-R11 all denied the allegation.

Allegation 2: Staff sprayed an unknown chemical into the resident's room
Staff 1-3 (S1-S3) and Residents 2-11 (R2-R11) stated staff is not spraying unknown chemicals into the resident’s room. R2-R11 stated they have no problems with staff and are happy living here. S1 stated that R1 is the only resident who reported that sprayed chemicals are coming from the sprinklers and vents. R1 also told her he was going to be killed by the chemicals' smell. S1 stated she went to R1’s room and did not smell or see any traces of chemicals. S1-S3 stated that R1 is never really at the facility and is independent. S1 stated R1 has a car and staff witnessed R1 sleeping in his car. S1-S3 stated R1 stated his room is being sprayed with chemicals and someone is trying to kill him. S1-S3 stated that R1 doesn’t really stay at the facility he leaves early in the morning and comes back later that evening. Resident 1 (R1) interviewed stated staff are spraying something under the door every night which causes him to get very sick and have headaches. S1-S3 and R2-R11 all denied the allegation.

Allegation 3: Staff stole the resident's belongings
Staff 1-3 (S1-S3) and residents 1-11 (R2-R11) stated staff does not steal residents' personal belongings. S S1 stated all residents have their own personal mailbox located in the mailroom on the first floor. R2-R11 stated they can get their mail out of the mail slot and do not have a problem with receiving their mail. R2-R11 stated staff will notify residents if they receive a large package and bring it to their rooms. S1 stated residents can get their mail from the mailroom no one is stealing the residents' mail. S1-S3 stated that they had not heard of any residents having problems receiving mail. Staff 1-3 stated they hadn’t heard anyone not receiving their mail. S1 stated once the United States Postal Service (USPS) delivers the mail it is sorted and distributed to all the residents' mail slots in the mailroom. S1 stated some of the resident’s families prefer mail to stay in the office and the residents will come and get their mail. LPA was able to observe the inside mail room, which was located on the first floor, and LPA did not see any concerns with mail. R1 stated staff are spraying something under his door every night which causes him to get very sick and have headaches. R1 stated staff members speak inappropriately to residents. R1 stated staff is not stealing the resident's personal belongings or mail. S1-S3 all denied the allegation. See LIC9099-C page 3

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230601120242

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: 06/06/2023

NARRATIVE

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Continued LIC9099-C page 2

***This amended LIC9099-C superseded the original LIC9099-C dated 06/06/2023.***

Investigation revealed the following: Staff 1-3 (S1-S3) and residents 2-11 (R2-R11) interviewed stated the allegations are all false. S1-S3 and R2-R11 stated staff does not speak inappropriately to residents. S1-S3 and R2-R11 stated residents are treated with dignity and respect and are in a safe, healthful, and comfortable environment. S1 stated staff members are expected to adhere to the highest standards of communication, ensuring that inappropriate language or behavior is never employed. S1 stated we emphasize the importance of treating all residents with dignity respect, and courtesy. S1-S3 and R2-R11 stated residents are free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. R2-R11 stated staff does not interfere with their daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning. S1-S3 denies any involvement in the alleged act of spraying an unknown chemical into R1's room through the R1 door, resulting in R1's illness and headaches. S1 stated they take such claims seriously and committed a thorough investigation to this matter to ensure the safety and well-being of all residents. S1-S3 and R2-R11 confirm that staff members do not engage in the theft of residents' personal belongings, including mail and clothing. S1 stated upon delivery of mail by the United States Postal Service, it is promptly sorted and distributed to the respective mail slots in the mailroom. S1 stated that R1 has not picked up his mail since 2021. S1 stated this is a duplicate complaint. S1 stated they never give R1 an eviction notice. S1-S3 and R2-R11 stated there is no occurrence of staff members stealing residents' clothes. On 06/08/2023, LPA Bunker interviewed resident 1 (R1) via telephone. R1 stated staff members speak inappropriately to residents. R1 stated staff are spraying something under his door every night which causes him to get very sick and have headaches. R1 stated staff members speak inappropriately to residents. R1 stated staff is not stealing the resident's personal belongings or mail. R1 is making contradicting statements. R2-R11 stated they were happy living here and had no problems, issues, or concerns. S1-S3 and R2-R11 interviewed denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. There were no deficiencies cited. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

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