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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603664
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:19:22 PM

Substantiated


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
04/10/2023 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20230410130004
FACILITY NAME:PATRICIA'S ELDER CAREFACILITY NUMBER:
197603664
ADMINISTRATOR:BRITO, PATRICIAFACILITY TYPE:
740
ADDRESS:2446 W. 234TH ST.TELEPHONE:
(310) 530-8946
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:David GenerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff caused bruises to resident in care.
Staff handles resident in a rough manner.

INVESTIGATION FINDINGS:
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On 04/26/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced subsequent complaint visit at this facility. LPA was greeted by Administrator David Gener and Caregiver Erlinda Basallo. LPA explained the purpose of the visit. LPA observed two staff and six residents present during the visit.

The investigation consists of the following: LPA Montoya interviewed two staff (S1-S2) and five residents (R1-R5). LPA was unable to interview one resident (R6) because he had difficulty staying awake due to medications. LPA interviewed one staff (S3) by telephone. LPA reviewed R1’s service records. A tour of the facility was conducted.

Report continued in LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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 6
Control Number 11-AS-20230410130004
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: 04/26/2023
NARRATIVE
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INVESTIGATIONS REVEALED:

Based on LPA’s records review, R1 was admitted to the facility on 2/1/2023. R1 is non-ambulatory, uses a wheelchair and not able to care own toileting needs and to bathe self. R1 is able to manage own prescription medications but prefers help from staff.


Regarding allegation: Staff caused bruises to resident in care.

Reporting Party (RP) reported staff constantly treat residents roughly, causing bruises.

LPA interviewed and obtained information from five out of six residents (R1-R6) and three staff (S1-S3). S1 stated there are four residents in the home that require assistance with activities of daily living (ADLs) either dressing, toileting, or transferring and other hygiene care. S1 stated S1 usually provides assistance to R5 and R6. S1 stated S2 and S3 usually provide ADL assistance to R1 and R3. S1 stated R2 and R4 require only minimal assistance with their ADLs. S1 stated however, any staff may assist any resident if needed. Interview with R1 and R3 revealed two staff (S2-S3) are rough when assisting residents with their incontinence and activities of daily living causing them bruises. S2 and S3 scrub residents’ body roughly until their skin turn red and staff put their weight on residents while changing residents’ diaper or clothes causing them bruises. S2 and S3 admitted they usually provide assistance to R1 and R3 with their ADLs, but they claim they handle them gently. Two other residents (R2-R4) and three staff (S1-S3) denied staff caused bruises on residents in care. R3 stated S2 and S3 cause resident bruises intermittently. LPA did not observe any bruises on R1 and R3 during the visit but based on LPA’s review of a photo taken on March 22, 2023, R1 had a circular light discoloration (bruise) on leg. Based on LPA’s investigation, there is sufficient evidence to prove that staff caused bruise on resident in care.

Regarding allegation: staff handles resident in a rough manner.


Reporting Party (RP) reported staff constantly treat residents roughly. Staff lean on resident’s body while providing assistance with their activities of daily living, pushing their weight onto the resident.

REPORT CONTINUED ON LIC 9099C

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20230410130004
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: 04/26/2023
NARRATIVE
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LPA interviewed and obtained information from five out of six residents (R1-R6) and three staff (S1-S3). S1 stated there are four residents in the home that require assistance with activities of daily living (ADLs) either dressing, toileting, or transferring and other hygiene care. S1 stated S1 usually provides assistance to R5 and R6. S1 stated S2 and S3 usually provide ADL assistance to R1 and R3. S1 stated R2 and R4 require only minimal assistance with their ADLs. S1 stated however, any staff may assist any resident if needed. Interview with R1 and R3 revealed two staff (S2-S3) are rough when assisting residents with their activities of daily living and incontinence care. S2 and S3 scrub residents’ body roughly until their skin turn red and staff put their weight on residents while changing residents’ diaper or clothes. S2 and S3 admitted they usually provide assistance to R1 and R3 with their ADLs, but they claim they handle them gently. Two other residents (R2-R4) and three staff (S1-S3) denied staff handle residents in a rough manner. Based on LPA’s investigation, there is sufficient evidence to prove that staff (S2 and S3) handle residents in a rough manner.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegations, "Staff caused bruises to resident in care.”, and “Staff handles resident in a rough manner.” are found to be SUBSTANTIATED.


According to the California Code of Regulations (Title 22, Division 6, Chapter 1,6), the following deficiencies had been observed and a citation issued (ref. LIC 9099D).

An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator David Gener.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20230410130004
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: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Administrator shall review Section 87468.1 of Title 22 and shall give staff an in-service training. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov.
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Based on observations, record review and interviews, S2 and S3 handle residents roughly causing them bruises. R1 had a bruise on leg while R3 claimed staff cause bruises on R3 intermitently due to rough treatment of staff during ADL care. This poses a potential health, safe and/or personal rights risk to residents in care,
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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: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
04/10/2023 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20230410130004

FACILITY NAME:PATRICIA'S ELDER CAREFACILITY NUMBER:
197603664
ADMINISTRATOR:BRITO, PATRICIAFACILITY TYPE:
740
ADDRESS:2446 W. 234TH ST.TELEPHONE:
(310) 530-8946
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:David GenerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff to not provide proper medication assistance to resident in care.
INVESTIGATION FINDINGS:
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On 04/26/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. LPA was greeted by Administrator David Gener. LPA explained the purpose of the visit. LPA observed two staff and six residents present during the visit.

The investigation consists of the following: LPA Montoya interviewed two staff (S1-S2) and five residents (R1-R5). LPA was unable to interview one resident (R6) because he had difficulty staying awake due to medications. LPA interviewed one staff (S3) by telephone. LPA reviewed R1’s service records. A tour of the facility was conducted.

Report continued in LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20230410130004
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: 04/26/2023
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Regarding allegation: Staff do not provide proper medication assistance to resident in care.

Based on LPA’s records review, R1 was admitted to the facility on 2/1/2023. R1 is able to administer own prescription medications but prefers staff to provide assistance. R1 is able to mobilize with the use of a wheelchair.

LPA interviewed five (R1-R5) out of six residents and three staff (S1-S3). During interview, four residents (R2-R5) and three (S1-S3) denied the allegation that staff do not provide proper medication assistance to residents in care. R4 administers own medications. R1 stated on 4/7/2023, S1 forgot to administer a medication to R1 but R1 was not able to name the medication. Per LPA's review of R1's medication administration records, there is no indication of a missed dosage on any of R1's medications. R1 is able to manage own medications and therefore, R1 is able to self-assist with medication administration when necessary. Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Based on LPA’s observation, interviews conducted, and records reviewed, 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(s) did or did not occur, therefore the above allegation is Unsubstantiated.


An exit interview was conducted with Administrator David Gener and a copy of the report was provided.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes MontoyaTELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6