191603774-7-14-2023-11-AS-JHAD-CU62L8-20230727172904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603774
Report Date: 07/14/2023
Date Signed: 07/14/2023 02:23:39 PM

Substantiated

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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230619094659

FACILITY NAME:	CANTERBURY, THE		FACILITY NUMBER:	191603774
ADMINISTRATOR:	DAVE HONE		FACILITY TYPE:	741
ADDRESS:	5801 WEST CRESTRIDGE ROAD		TELEPHONE:	(310) 541-2410
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90274
CAPACITY:	187	CENSUS: 109	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Dave Hone, Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure the elevator was working properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with dave Hone, executive Director.

The investigation consisted of following: Interviews and Record reviews. LPA Soto conducted interviews with the S#1 - Executive Director, S#2 -S#5, R#1 -R#6. The LPA also requested copies of the following documents: Resident and Staff rosters, Copies of R#1 file - Face sheets, Physicians report, Services Plan, Pre-Appraisals, Physician's Report, Current Repair Service Invoice for elevator (June 2023 & Copy of Past invoices -last 6 months,) and Incident report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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-20230619094659

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
MONTEREY PARK, CA 91754

FACILITY NAME: CANTERBURY, THE	FACILITY NUMBER: 191603774
	VISIT DATE: 07/14/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Staff did not ensure the elevator was working properly. Interviews with S#1 – S#5, communicated that the elevator in building A does break down but they fix it right away. It’s broken down a couple times in the past 6 months. Interview with S#2 communicated that the elevator in building A has broken down 5 times in the last six months. The 1^st time was in January of 2023, it’s only normal wear and tear. In June 2023, the sensors of the doors sensed a problem and it shut the elevator down. They have a company that comes and repairs the elevator. They fixed the sensor of the elevator doors and now it works properly. The facility makes sure the company comes right away to fix it; the elevator doesn’t stay broken down too long this past time it was fixed in 4 hours. Interviews with R#1 – R#6, communicated that the elevator has been breaking down. Sometimes they notice the elevator broken down and most of the time the facility let’s them know the elevator is not working and they are repairing it. They usually don’t take long to repair it but does pose a problem when it’s not working like they miss appointment, meeting, and going out. Unfortunately, they cannot use the stairs, so they just stay in their rooms until it gets fixed. LPA reviewed the repair invoices for the elevator in building A, they have come out 5x in the last 6 months to repair the elevator. The interviews conducted and records review did concur with the above allegation.

Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

An exit interview was conducted with Dave Hone, Executive Director, and a hard copy of report was provided along with the Appeal Rights.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230619094659

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
MONTEREY PARK, CA 91754

FACILITY NAME: CANTERBURY, THE	FACILITY NUMBER: 191603774
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/19/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) The facility shall be clean, safe, sanitary and in good repair at all times....This was not met as evidence. Based on elevator broke down for 4 hours and then fixed. Which poses a potential risk for persons in care.	1 2 3 4 5 6 7	Corrected at the time of visit.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

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