191671691-2-29-2024-11-AS-UCOL-D3BQ3Y-20240313114929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191671691
Report Date: 02/29/2024
Date Signed: 02/29/2024 03:19:07 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, 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
08/24/2022 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20220824113729

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: 114	DATE:	02/29/2024
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Administrator - Amalia Esquivias		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not follow quarantining protocol
Facility does not meet resident's incontinence needs
Staff did not regularly monitor resident for change in condition
Staff do not answer resident call button in a timely manner

INVESTIGATION FINDINGS:

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On 02/29/2024 at around 8:20 AM Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegations listed above. LPA met with the Administrator Amalia Esquivias and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA and the Administrator conducted a tour of the facility which included the dining room, living room, activity room, patio, and random resident bedrooms. LPA interviewed 5 out of 114 residents and 4 out of 72 staff members. LPA conducted a record review which consisted of 5 Residents Files, Personnel Report, Resident Roster, Facility Infection Control Requirements, and Inspection Guidelines for Infection Control.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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-20220824113729

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 02/29/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation "Staff did not follow quarantining protocol” it is being alleged that during resident’s quarantining staff refused to enter resident’s room. 3 out 5 residents indicated that staff provided in person services to them during their quarantining. 5 out of 5 staff interviews indicated that for residents who are quarantining, staff go into their bedrooms and provide them with services. Record reviews demonstrate that the facility has a Facility Infection Control Requirements Plan and an Inspection Guidelines for Infection Control.

The investigation revealed the following: Regarding the allegation "Facility does not meet resident's incontinence needs” it is being alleged that staff failed to provide incontinence care and due to this a resident developed a UTI and blisters on their genital area. 3 out of 3 residents who receive incontinence care indicated that staff assist them with their incontinence needs. 4 out 4 caregivers interviewed indicated that they check residents every 2 hours but, in some cases, they check them every 30 minutes. Record review shows Resident’s 1 Resident Call Log and Bowel Movement Log and it demonstrates a daily log of how often they are checked and changed.

The investigation revealed the following: Regarding the allegation "Staff did not regularly monitor resident for change in condition” it is being alleged that staff did not observe blisters on resident’s genital area. 5 out 5 residents indicated that staff check up on them every day. 4 out of 4 caregiver interviews indicated that they continuously observe their residents for change of condition and if there is a change they notify the medical technician, licensing vocational nurse, or the Administrator. Record Reviews of Resident 1 demonstrate various daily logs of their Resident Call Log, Bowel Movement Log, and Meal/Fluid Intake.

The investigation revealed the following: Regarding the allegation "Staff do not answer resident call button in a timely manner” it is being alleged that sometimes staff answers the call button in 30 minutes, and it takes them another 30 minutes to arrive to the residents’ room. 3 out 5 residents who use the call button indicated that they come in a timely manner to their room. 4 out 4 caregiver interviews indicated that they go to residents’ rooms in an adequate amount of time and if they are unable to go then another staff member will assist the resident. LPA checked random call buttons and found that the average response time was in less than 1 minute, there was only one call button that took about 4 minutes for staff to respond.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20220824113729

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 02/29/2024

NARRATIVE

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Regarding the allegation "Staff did not follow quarantining protocol,” “Facility does not meet resident's incontinence needs,” “Staff did not regularly monitor resident for change in condition,” “Staff do not answer resident call button in a timely manner” The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

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