191671691-6-11-2022-11-AS-JHAD-CGS2M9-20220728173045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191671691
Report Date: 06/10/2022
Date Signed: 06/11/2022 10:16:42 AM

Unfounded

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
06/03/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220603115949

FACILITY NAME:	CROFTON MANOR INN		FACILITY NUMBER:	191671691
ADMINISTRATOR:	AMALIA ESQUIVIAS		FACILITY TYPE:	740
ADDRESS:	1950 E. 5TH ST.		TELEPHONE:	(562) 437-0093
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	213	CENSUS: 107	DATE:	06/10/2022
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Amalia Esquivias		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Resident's belongings are not being safeguarded in their room while in care.

INVESTIGATION FINDINGS:

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On 06/10/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Amalia Esquivias.

The investigation consisted of interviews and record reviews. A review of the following documents: Resident roster, Staff roster, ID/Emergency, Physician's Report, Medication Administration Records, Resident Appraisal, Advance Health Care Directive, Employee Mandated training, and other pertinent documents associated with resident #1 (R1). On 06/10/22, LPA Dabuet interviewed residents #1-#9 (R1-R9), witnesses #1-(W1), and staff #1-#3 (S1-S3). A tour of the facility was conducted.

Evaluation Report continues on LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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-20220603115949

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 06/10/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident's belongings are not being safeguarded in their room while in care.

It is alleged this facility did not safeguard resident #1 (R1’s) personal property while in care. The details of the allegation state that (R1) personal bank card was compromised with several unauthorized fraudulent transactions from P & B Liquor in Long Beach, CA on 04/29/22. According to the complainant, (R1) does not suspect anyone, however, states multiple individuals go in and out of her room and did not have further additional information to provide to the Department on the incident. The Department inspected the facility along with the Administrator Amalia Esquivias staff #1 (S1) and observed at 10:00 am (R1’s) room door was wide open unattended by (R1). An interview with (R1) claims she does not have any valuables and that she has a lockbox with a padlock that she owns. However, she does not use it often and forgets to use it. (R1) admits that she is uncertain if the fraudulent transactions on her bank card were made by anyone from this facility. (R1) admits she takes responsibility for neglecting at times to shut her door completely and she does have the habit of leaving it open. (R1) states she left her room with her purse with valuable items in her purse and did not find anything missing. (R1) admits finds the staff and residents to be trustworthy individuals and does not accuse them of the unauthorized transactions.

(R1) claims she does not handle her finances and that her friend witness #1 (W1) is responsible for her financial and legal affairs. An interview (W1) claims this is all a misunderstanding and that there is no fraud involved with her finances. (W1) clarifies she reviewed the transaction on (R1’s) statements and notice these questionable charges from P&B. (W1) requested to see receipts and review the camera footage from 04/29/22. The surveillance footage at P&B revealed that (R1) had made several purchases of alcohol items. According to (W1), (R1) often will have unusual forgetfulness moments. (W1) states a new debit card was reissued and recommended for (R1) to store her valuables locked in her lockbox. (W1) claims the allegation is untrue and these transactions of (R1) are valid and not fraud. (W1) added the facility has provided (R1) safe and comfortable accommodations. Interviews conducted with (R2-R9) did not have any concerns with their personal property items and states the facility did an excellent job to safeguard their valuable items. (R2-R9) claims they are aware that lockboxes are provided upon request. (R2-R9) all feel, that although, the facility does have a responsibility to safeguard their valuables; it is also the responsibility of residents to ensure they follow the proper security guidelines and shut their doors completely and not make themselves accessible to intruders.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220603115949

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 06/10/2022

NARRATIVE

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Interviews with (R1-R9) all reported that themselves have not encountered any personal property items missing and that the staff is professional and trustworthy. Interviews conducted with staff #1-#3 (S1-S3) claims they had no knowledge of resident's personal belongings were not being safeguarded. (S1-S3) states staff abides by the house rules and will announce their presence before entering a resident room. (S1-S3) reported they have often observed (R1’s) with an open door unattended and will shut the door for the resident when she is not in her room. (S1-S3) verified staff have all completed various mandatory training courses including subject on Ethics.

Based on information gathered, an inspection of the facility, observation, analysis of (R-1)'s service records, and interviews conducted, the Department found no evidence to support the allegation listed on this complaint report.

This agency has investigated the complaint alleging " Resident's belongings are not being safeguarded in their room while in care.". We have found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview held, and a copy of this report was provided to Amalia Equivias.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC9099 (FAS) - (06/04)

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