197602370-7-17-2024-11-AS-UCOL-D8DNPL-20240822103831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602370
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:08:36 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
07/09/2024 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20240709163834

FACILITY NAME:	PINNACLES AT BURTON, THE		FACILITY NUMBER:	197602370
ADMINISTRATOR:	CHANEL ANN SANCHEZ		FACILITY TYPE:	740
ADDRESS:	8757 BURTON WAY		TELEPHONE:	(310) 278-8323
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	138	CENSUS: 24	DATE:	07/17/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Administrator - Chanel Ann Sanchez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure facility elevator is in good repair resulting in resident sustaining an injury.
Staff did not inform resident's responsible party.

INVESTIGATION FINDINGS:

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On 07/17/2024 at around 10:20 AM Licensing Program Analyst (LPA), Leandro conducted a complaint investigation regarding the allegations listed above. LPA met with Administrator, Chanel Ann Sanchez and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA, and Administrator conducted a tour of the facility which included checking the facility elevators. LPA interviewed 1 out of 24 residents and 4 out of 32 staff. LPA reviewed resident census, personnnel report, Resident 1’s records, and elevator maintenance information.

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: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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-20240709163834

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: PINNACLES AT BURTON, THE	FACILITY NUMBER: 197602370
	VISIT DATE: 07/17/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation “Staff did not ensure facility elevator is in good repair resulting in resident sustaining an injury,” it is being alleged that Resident 1 (R1) sustained a laceration on her leg via elevator on 07/06/2024, due to elevator being in disrepair. LPA observed elevator being in good repair. Interviews conducted indicated that the elevator has recently received maintenance. Records review indicated that elevator has undergone inspection by the City of Los Angeles Department of Building and Safety on 07/02/2024. Regarding the allegation, 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.

Regarding the allegation “Staff did not inform resident's responsible party” it is being alleged that staff did not inform R1’s responsible party (family) of the injury. Interviews conducted revealed that R1’s family member had been notified the day of the incident. Record review revealed that R1’s family member had been notified the day of the incident. Regarding the allegation, 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, and a copy of this report was left with the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC9099 (FAS) - (06/04)

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