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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603774
Report Date: 04/11/2025
Date Signed: 04/11/2025 04:21:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2025 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250403121056
FACILITY NAME:CANTERBURY, THEFACILITY NUMBER:
191603774
ADMINISTRATOR:DAVE HONEFACILITY TYPE:
741
ADDRESS:5801 WEST CRESTRIDGE ROADTELEPHONE:
(310) 541-2410
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY:187CENSUS: 137DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
08:14 AM
MET WITH:Nicole Prescott , Nurse ManagerTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff administered resident a suppository without a prescription
INVESTIGATION FINDINGS:
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On 04/11/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by staff two, Diana Ernandes Activities Coordinator (S2) and later by staff one, Nicole Prescott Nurse Manager (S1), and the purpose of the visit was explained. LPA was granted entry to the facility. S1 and LPA toured the first floor and basement of the facility.
The investigation consisted of the following:
On 04/11/25 LPA requested and reviewed facility documents, including the following: Resident roster (dated 04/10/25), staff roster (dated 04/11/25), various facility documentation and all communications between the facility, their contracted Physician and the most updated Dr.'s orders for a resident in care.
LPA interviewed five (5) out of one-hundred and thirty-seven (137) residents (R1-R5), eight (8) out of two-hundred and ninety-one (291) staff (S1-S8) and one (1) witness.

Report continues, see LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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 4
Control Number 11-AS-20250403121056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CANTERBURY, THE
FACILITY NUMBER: 191603774
VISIT DATE: 04/11/2025
NARRATIVE
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Investigation revealed the following:
Regarding the allegation, "Staff administered resident a suppository without a prescription", it has been alleged that staff have provided a suppository without Dr.'s orders. LPA conducted record reviews of the changes in a resident's primary care physician, listed in order from oldest to newest: Dr. Anna Mellor (AM) from May 2015 (05/15) to March 2021 (03/21), Dr. Christopher Traughber (CT) from 03/21 to March 2025 (03/25), now Dr. Robert Reiss (RR) from 03/25 to current date (04/11/25). LPA reviewed a fax to RR, who ordered, and confirmed, the use of an over-the-counter (OTC) medication following a request from a resident's responsible person(s). RR only confirmed OTC, starting 03/26/25, and did not discontinue (DC) a suppository. LPA further reviewed the medication administration record (MAR) of a resident from the months of February, 2025 (02/25) to April, 2025 (04/25). During the dates in question, there has not been any marked dose of a suppository to a resident in care. On 04/11/25, between 09:00AM and 1:00PM, LPA interviewed eight (8) staff (S1-S8). Between 2:00PM and 4:00PM, LPA interviewed five (5) residents (R1-R5). All eight (8) staff interviewed (S1-S8) and five (5) out of five (5) residents interviewed (R1-R5) have denied the allegation has taken place, while witness one (1) is unsure whether the allegation has taken place. Based on record reviews and interviews conducted, 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.

There have been no deficiencies cited during today's visit.

An exit interview was held with staff one, Nicole Prescott Nurse Manager (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4