191601613-9-27-2023-11-AS-UCOL-CYQQHC-20231221111056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191601613
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:20:24 AM

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
09/21/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20230921095714

FACILITY NAME:	WILMINGTON GARDENS		FACILITY NUMBER:	191601613
ADMINISTRATOR:	FLORES,V.ANDT.		FACILITY TYPE:	735
ADDRESS:	1311 WEST ANAHEIM STREET		TELEPHONE:	(310) 835-6366
CITY:	WILMINGTON	STATE: CA	ZIP CODE:	90744
CAPACITY:	48	CENSUS:	DATE:	09/27/2023
		UNANNOUNCED	TIME BEGAN:	07:57 AM
MET WITH:			TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not preventing a resident from harming other resident (s).
Staff di not seek medical attention for resident in a timely manner.
Staff threaten resident in care.

INVESTIGATION FINDINGS:

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On 09/27/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings regarding the above allegations. LPA Richard met met with Rosemary Chandler the Caregiver/Housekeeper, and later was joined with administrator Flores.

The investigation consisted of the following:
On 09/26/2023, LPA Richard and LPM Ulysses toured the facility inside and out with Administrator Flores. LPA Richard reviewed and requested staff and client's records. LPA interviewed five (C1-C5) clients, and five staff (S1-S5). LPA Richard requested and reviewe and collected facility documents.
On 09/27/2023, LPA Richard conducted a subsequent complaint to deliver findings regarding the above allegations. LPA met with Rosemary Chandler the Caregiver/Housekeeping, and later was joined with administrator Flores. LPA Richard and Adminitrator Flores toured the physical plant.

Report Continues, See LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-20230921095714

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: WILMINGTON GARDENS	FACILITY NUMBER: 191601613
	VISIT DATE: 09/27/2023

NARRATIVE

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The investigation revealed the following:

Regarding allegation: Staff are not Preventing a resident from harming other resident.

On 09/26/2023, LPA interviewed staff S1-S5 about the allegation above, and all staff denied the allegation. The staff also stated they tried to separate the clients from fighting each other; the clients were grown men, and there was only so much they could do. LPA interviewed clients C1-C5, and all clients stated that they do not very often see clients fighting each other.

Based on LPA interviews LPA did not find sufficient 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 did or did not occur. Therefore, the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff did not seek medical attention for resident in timely manner.

On 09/26/2023, LPA interviewed clients S1-S5 about the allegation above, and all staff denied the allegation. Staff stated they do call 911 when a client needs medical attention. Sometimes, the 911 operator wants to know if the client is bleeding or it's life-threatening; if not, 911 doesn't show up quickly. LPA interviewed clients C1-C5, and all clients stated they were OK with how the staff helped them when they needed to go to the hospital.

Regarding allegations: Staff threaten resident in care.

On 09/26/23, LPA interviewed staff S1-S5 about the allegation above, and all staff denied the allegation; 4 out of 5 staff stated that the clients were the ones who threatened them. Sometimes, the clients verbally curse at them for no reason at all. LPA interviewed Clients C1-C5 about the allegation above and all the clients denied staff threatened them, however 1 out of 4 clients stated that staff didn't like the way client talked to them.

Exit interview conducted. A copy of the report and Confidential Names LIC811 were provided to Flores the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC9099 (FAS) - (06/04)

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