197603664-7-14-2023-11-AS-MVAO-CUYU2B-20230823151141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603664
Report Date: 07/14/2023
Date Signed: 07/14/2023 11:33:22 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
06/21/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230621145621

FACILITY NAME:	PATRICIA'S ELDER CARE		FACILITY NUMBER:	197603664
ADMINISTRATOR:	BRITO, PATRICIA		FACILITY TYPE:	740
ADDRESS:	2446 W. 234TH ST.		TELEPHONE:	(310) 530-8946
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 5	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Gener David		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff is not following resident's diet
Staff is not providing proper toileting services to resident in care
Staff did not properly clean resident's room
Staff is interfering with resident's relocation

INVESTIGATION FINDINGS:

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On 06/23/2023, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint investigation to address the allegation(s) listed above. LPA Scott met with Gener David, Administrator, and explained the purpose of this visit is to gather information for the complaint.

The investigation consisted of the following:

On 06/23/2023, LPA Scott interviewed two staff (S1-S2) and three residents (R1-R3). LPA reviewed all resident files and obtained copies of staff /resident roster, admission agreements, physician reports, Id/Emergency information, appraisal/needs and service plan, and preplacement appraisal.

The Investigation revealed the following:

Regarding allegation #1: Staff is not following resident's diet

It was reported that the resident was supposed to be on a diabetic diet and the administrator was not complying with the doctor’s orders. LPA interviewed two staff (S1-S2) and three residents (R1-R3). Both staff denied that they are not following the resident’s diet. S1 and S2 both stated that they are following the menu provided by R1. 2 of 3 residents denied that the facility was not following their diet plan. R2 and R3 both stated that the facility is adhering to their diet plan.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
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)

Page: 1 of 3

Control Number 11-AS-20230621145621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PATRICIA'S ELDER CARE	FACILITY NUMBER: 197603664
	VISIT DATE: 07/14/2023

NARRATIVE

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Based on interviews there is insufficient evidence to support the allegation: Staff is not following resident's diet. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

Allegation # 2: Staff is not providing proper toileting services to resident in care

It was reported that the staff is not providing proper toileting services to the resident. When interviewed both staff (S1-S2) denied the allegation. Both stated that the resident’s portable toilet is emptied more than four times per day or as needed. Staff also stated that R1 has sanitary wipes, and the facility has more than enough for the residents. R1 confirmed that the staff empties the portable toilet four or more times per day. The other resident’s R2-R3 report that they’re not incontinent and don’t require those type of services.

Based on interviews there is insufficient evidence to support the allegation: Staff is not providing proper toileting services to resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

Allegation #3: Staff did not properly clean resident’s room

It was reported that the resident’s room was very dusty, and mold was in the restroom. Both staff (S1-S2) denied the allegation. Both stated that all residents’ rooms were cleaned daily. 2 of 3 residents interviewed confirmed that the staff cleans their rooms daily. LPA toured the residents’ bedrooms and bathroom, and found them to be clean and had no mold in the bathroom.

Based on interviews there is insufficient evidence to support the allegation: Staff did not properly clean resident’s room. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

Allegation # 4: Staff is interfering with residents’ relocation

It was reported that the administrator was interfering with the resident’s relocation. The resident states that the resident has been blackballed by the administrator from finding another facility. When interviewed both staff (S1-S2) denied the allegation. Both stated they were aware of the resident wanting to find a new facility and neither of them has interfered in that process. When interviewed about moving from the facility and staff interfering with that move R1 confirmed that no one was interfering with R1’s moving. R1 stated R1 has been trying to move since March of 2023 but can’t afford anything else.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
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-20230621145621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PATRICIA'S ELDER CARE	FACILITY NUMBER: 197603664
	VISIT DATE: 07/14/2023

NARRATIVE

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Based on interviews there is insufficient evidence to support the allegation: Staff is interfering with residents’ relocation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies were cited.

An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator, Gener David.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
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)

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