197606651-10-31-2022-28-AS-RORN-CLPVHJ-20221201152714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606651
Report Date: 10/31/2022
Date Signed: 10/31/2022 11:21:52 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/26/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221026132427

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: 64	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Jeenne Decastro		TIME COMPLETED:	11:45 PM

ALLEGATION(S):

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Facility is refusing to readmit resident back from hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint investigation regarding the allegation listed above and LPA met with receptionist Rita Pena and explained the purpose of the visit. Shortly after, the assistant administrator Jeenne Decastro arrived and assisted with the visit.

The investigation consisted of the following: LPA interviewed the administrator, staff#1 (S1) and four residents (R1-R4) and also obtained copy of R1's face sheet, physician report dated on 10/10/22, R1's discharge summary final report and Medication Administrative Records (MARs) and reappraisal dated on 10/25/22.

The investigation revealed of the following: In regards to the allegation of "Facility is refusing to readmit resident back from hospital. " LPA interviewed residents and they all like living in the facility and all staff are treating them very good.
(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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-20221026132427

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 10/31/2022

NARRATIVE

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LPA interviewed the assistant administrator and denied the allegation and reported its a misunderstanding between hospital and facility and R1 already discharged back to the facility last week. Assistant Administrator reported that the facility only wanted to complete a reassessment before R1 returned back to the facility. The facility only wanted to follow the protocol and ensure R1 is safe to return back to the facility without higher level of care. The facility never denied or refused R1's returning. Assistant Administrator stated that due to R1 was in the hospital for two weeks and they observed R1 through face time and R1 was having a hard time standing up and R1 was very weak at that time. Therefore, the facility requested a clearance order from hospital for R1 to return from facility.

Based upon interviews and records reviewed, the findings indicate that 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. A copy of the report and appeal right was provided to Assistant Administrator Jeenne Decastro.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

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