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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603774
Report Date: 07/16/2020
Date Signed: 07/16/2020 06:55:02 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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2020 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20200709101511
FACILITY NAME:CANTERBURY, THEFACILITY NUMBER:
191603774
ADMINISTRATOR:SHARON PEWTRESSFACILITY TYPE:
741
ADDRESS:5801 WEST CRESTRIDGE ROADTELEPHONE:
(310) 541-2410
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY:187CENSUS: 143DATE:
07/16/2020
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Dave Hone-exacutive directorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not provide adequate food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted via Google Duo with Dave Hone, the facilities executive director. LPA explained the purpose of this telephonic visit is to gather information regarding the complaint allegation.

The investigation consisted of the following:
On 7/14/2020 LPA Cifuentes conducted a video call with the administrator. During the call, LPA spoke with administrator and dining director, was shown dining room, kitchen and client rooms. LPA requested and received the following documents: resident and staff rosters, menu's for June 2020 and July 2020 and staff training. On 7/16/2020 LPA requested and received medical reports for residents 1-3, and discharge forms for residents 3.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020
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-20200709101511
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
MONTERY PARK, CA 91754
FACILITY NAME: CANTERBURY, THE
FACILITY NUMBER: 191603774
VISIT DATE: 07/16/2020
NARRATIVE
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Regarding the allegation: Staff did not provide adequate food service

The investigation revealed the following:

On 7/14/2020 LPA Cifuentes conducted a video call with the administrator. During the call, LPA spoke with administrator and dining director, Renato Ramirez, and toured dining room, kitchen and client rooms. Dining director told LPA that all kitchen staff from the dish washers to the cooks have ServeSafety certifications and the facility gives kitchen staff extra training on kitchen safety protocols as well. LPA observed that items received by facility had orange stickers with date item was received by facility. A different sticker is used by kitchen staff to label those items that have been opened, with date item was opened. Those items that were prepared on 7/14/2020 for the dinner meal, like desserts and beverages were also labelled to show date items was made. LPA was also told that food temperatures are taken throughout the cooking process, during plating of meal, and right before it is distributed to facility residents to ensure that items are correctly cooked and that foods remain heated or not as required to remain within adequate safety guidelines.

On 7/16/2020 LPA reviewed facility files. Medical report for resident 1 show that resident was admitted to hospital for vomiting and abdominal discomfort do to a uretral stone, that was later removed during surgery.

On 7/16/2020 LPA interviewed facility residents. 10 out of 10 residents stated that they had not gotten sick from facility food. 9 out of 10 residents stated they had not heard of anyone getting sick from the food served at the facility. LPA also asked residents it food was served hot, to which 7 out of 10 stated that food arrived to their rooms hot.

On 7/16/2020 LPA Cifuentes interviewed facility staff. 10 out of 10 staff interviewed stated residents had not gotten sick from the food, with 9 out of 10 stating that food was delivered hot to residents.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20200709101511
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
MONTERY PARK, CA 91754
FACILITY NAME: CANTERBURY, THE
FACILITY NUMBER: 191603774
VISIT DATE: 07/16/2020
NARRATIVE
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Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of the report was emailed to Dave Hone, executive director.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3