197603664-7-24-2023-11-AS-UCOL-CWKNFQ-20231013102554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603664
Report Date: 07/19/2023
Date Signed: 07/24/2023 08:56:56 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
07/17/2023 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230717150226

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: 6	DATE:	07/19/2023
		UNANNOUNCED	TIME BEGAN:	07:57 AM
MET WITH:	Gener David, Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek timely medical attention for a resident while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

**This report is being amended with correct information and remove deficiencies.**

On 07/19/2023 at 8:05 AM Licensing Program Analyst (LPA) David España met with met with Gener David, Administrator and Linda, caregiver to conduct a complaint investigation to address the allegations listed above. LPA España discussed with Gener David, Administrator and explained the purpose of this visit.

The investigation consisted of the following: LPA España conducted a tour of the facility grounds. LPA España interviewed staff, clients, witnesses, and reviewed records. LPA España requested and reviewed the following documents: client roster; staff roster; LIC 601 - Identification and Emergency Information; LIC 602A - Physician's Report; LIC 627C - Consent for Emergency Medical Treatment; LIC 625 - Appraisal Needs and Services Plan, and LIC 603A - Resident Appraisal (i.e., All resident files will be submitted to LPA by Friday, July 21, 2023, via email David.espana@dss.ca.gov or fax). The investigation revealed the following: Regarding the allegation “Staff did not seek timely medical attention for a resident while in care.”

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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-20230717150226

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: 07/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It’s being alleged the facility has not provided a comfortable environment as it relates to medical attention for residents.

1 out of 6 residents interviewed agreed with the allegation.

3 out of 6 residents have denied having any issues that staff has failed to provide a comfortable environment as it relates to medical attention for residents.

2 out of 6 resident was not able to provide interview.

2 out of 2 staff denied the allegation, S1 & S2 denied providing uncomfortable environment as it relates to medical attention for residents: Concerning the allegation “Staff did not seek timely medical attention for a resident while in care.”

Based on interviews conducted, record reviews and observation, the preponderance of evidence standard has not been met. 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 allegation is unsubstantiated.

An exit interview was conducted with Gener David, Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20230717150226

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES	PLAN OF CORRECTIONS(POCs)
Type B CCR	1 2 3 4 5 6 7	1 2 3 4 5 6 7
	8 9 10 11 12 13 14	8 9 10 11 12 13 14
CCR	1 2 3 4 5 6 7	1 2 3 4 5 6 7
	8 9 10 11 12 13 14	8 9 10 11 12 13 14

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: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3