197606651-4-8-2024-28-AS-FFIS-D45VFU-20240408162428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606651
Report Date: 03/29/2024
Date Signed: 04/08/2024 12:22:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/26/2022 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220126151537

FACILITY NAME:	LAKEWOOD GARDENS		FACILITY NUMBER:	197606651
ADMINISTRATOR:	SHOLOM YOSEF GOLDMAN		FACILITY TYPE:	740
ADDRESS:	12055 S. LAKEWOOD BLVD.		TELEPHONE:	(562) 869-4038
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	150	CENSUS: 76	DATE:	03/29/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jeenie De Castro- Administrator.		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility has bed bugs.
Resident was prohibited from using their bathroom.
Resident's Representative was prohibited from installing a safety bed alarm for resident.
Resident was forced to wear diapers while in care.
Facility has bad odor

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sanjay Vaid conducted a subsequent complaint visit regarding the allegations and discussed the findings of the complaint investigation. LPA Vaid met with Administrator Jennie De Castro and discussed the purpose of the visit, which was to deliver complaint investigation findings.

On 01/28/2022 LPA Nina Galarza toured the physical plant, including rooms 11,43,34,74,33,25, and 75 with Staff #1 (S1). LPA conducted interviews with Administrator, S1 and Resident #1 (R1). LPA obtained copies of; staff roster resident roster, and most recent pest control receipt.

On todays visit, LPA Vaid interviewed residents and Administrator, and staff, and toured the physical plant with administrator DeCastro and LPA observed the facility to be in good repair and cleanliness all around, rooms included in tour were Rm 11, 13, 25, 33, 34, 43, 44, 52, 74 and 75. LPA requested and obtained a copy of staff schedule and rsident roster, including a list of any residents receiving incontinent care and pest control invoices. LPA Vaid observed the facility has no malodor. LPA tour was comprised of interviews with R#1-R#10 residents in the above rooms and interviewed S#2-S#7 staff (administrator, caregivers, housekeepers, maintenance) working today. Con't on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

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 28-AS-20220126151537

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 03/29/2024

NARRATIVE

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Regarding allegation: Facility has bed bugs. It is alleged, a resident was observed by medical staff whom indicated resident appeared to have been bitten by bed bugs. 10 out of 10 resident interviews revealed the residents are unaware of bedbugs in the facility. 7 out of 7 staff interviews revealed that the facility is free of pests including bedbugs. Interviews with Administrator revealed monthly pest control invoice show no detection of pests. LPA observed bedding and linens on beds to be clean and no bed bugs were seen today. Review of pest control invoices indicate monthly pest control checks are made to the facility, no pests found on both visits according to Pest Control Company dated 2/26/24 and 3/14/24.

Regarding allegation: Resident's Representative was prohibited from installing a safety bed alarm for resident. It is alleged that resident family requested a bed alarm be placed on resident bed due to resident falls, however, the staff delayed processing the request and ignored the request. 10 out of 10 resident interviews revealed they are not aware of this. 7 out of 7 staff interviews revealed bed alarms are placed only after physician’s order is reviewed and verified. Interview with Administrator revealed R1’s physician report dated 10/22/2021 revealed no written order for bed alarm was given. The report indicates use of low bed, therefore bed alarm was not approved by physician. No written order on file.

Regarding allegation: Resident was forced to wear diapers while in care. It was alleged, staff placed adult briefs on resident in order to keep resident in bed during the time resident bathroom access was blocked.
10 out of 10 resident interviews revealed they are not forced to wear adult briefs. 7 out of 7 staff interviews revealed if there is a physicians order on file only then can staff provide adult briefs/ diapers to residents. Interviews with Administrator revealed the residents are provided adult briefs only upon physician’s orders and as indicated in Needs and Service plan, Physicians report for R1 dated 10/22/2021 recommended use of adult briefs due to use Foley catheter and to prevent resident from soiling self.

Con't on 9099 C....

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220126151537

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 03/29/2024

NARRATIVE

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Regarding allegation: Facility has bad odor. It is alleged, that a visitor smelled urine coming from a sliding door due to a resident urinating by the sliding door.
10 out of 10 resident interviews revealed the residents has not experienced bad odor from the facility.
7 out of 7 staff interviews revealed only bad smell occurs when residents have bladder/bowel movements in the clothes, the staff acts quickly to clean and eliminate the smell of urine and/or feces. Interviews with Administrator revealed the facility to be clean and odor free, housekeeping is very good at keeping facility clean and odor free. Caregivers assist residents if the clothes become soiled after bladder/bowel accidents.

Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted with Administrator Jennie De Castro. A copy of the licensing report was provided at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

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