197607201-12-29-2021-11-AS-AJKK-CCXUU4-20220328155252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607201
Report Date: 12/29/2021
Date Signed: 12/29/2021 01:28:12 PM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/23/2021 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211223160107

FACILITY NAME:	GOLDEN CITY HOME CARE		FACILITY NUMBER:	197607201
ADMINISTRATOR:	ANTONIA DIONISIO		FACILITY TYPE:	740
ADDRESS:	2451 W. 230TH STREET		TELEPHONE:	(310) 325-1995
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 6	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Antonia Dionisio		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident's bathroom is unsanitary and malodorous.
Resident's diapers are not properly disposed.
Resident's laundry needs are not being met.

INVESTIGATION FINDINGS:

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On 12/29/2021, Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the following allegations. LPA Agard was met with Antonia Dionisio, Administrator and explained the purpose of the visit was to gather information regarding this complaint.

The investigation consisted of the following: LPA taking a tour of the facility. Checking all bedrooms, restrooms and laundry areas specifically, interviews with staff, residents and requesting records. The following records were requested: 1) Resident and staff roster.

On 12/29/2021 LPA Agard delivered findings.

Regarding the allegation: Resident's bathroom is unsanitary and malodorous. It’s being alleged that a resident bathroom smelled strongly of urine and feces remains. The investigation revealed the following.
Cont. 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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-20211223160107

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN CITY HOME CARE	FACILITY NUMBER: 197607201
	VISIT DATE: 12/29/2021

NARRATIVE

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S1 & S2 both confirmed that there was an event when a resident used the facility restroom and was in the process of cleaning up after the resident had an accident. “S1 states, “last week there was a client that went to the bathroom and made a big mess.” S2 states the resident had just got done making a mess and they were in the process of cleaning when a visitor showed up.” During interviews with residents 2 of the 2 could not confirm the allegation to be true due to being bed bound. LPA was unable to conduct interviews with 4 residents due to communication barriers. During interviews with witnesses, 3 of the 3 could not confirm the allegation to be true. W1 denied the allegation and states they never noticed the facility restroom being unsanitary. W2 states the bathroom could be cleaner but it isn’t horrible. W3 states they do not use the facility restroom and could not confirm. LPA observed the facility bathroom to be clean, sanitary and free from odor

Regarding the allegation: Resident's diapers are not properly disposed. It’s being alleged that a resident’s bathroom wastebasket consisted of remains of feces and used incontinent diapers. The investigation revealed the following. S1 & S2 both confirmed that there was an event when a resident used the facility restroom and was in the process of cleaning up after the resident had an accident. S2 states the diaper was discarded while in the bathroom and because they were in the process of cleaning up the resident, they neglected taking out the trash at that moment. During interviews with residents 2 of the 2 could not confirm the allegation to be true due to being bed bound. R1 and R2 both state that they are changed regularly and have no complaints. LPA was unable to conduct interviews with 4 residents due to communication barriers. During interviews with witnesses, 3 of the 3 could not confirm the allegation to be true. W1 states they have never observed a diaper being disposed inappropriately and their family member is changed regularly. W2 states they could not confirm if diapers are being disposed of inappropriately. “I can’t say for sure, to be honest.” W3 states during visits, they change their relative and places a soiled diaper in a basket with a plastic bag and the facility staff take the plastic bag to the trash. LPA did not observe any wastebasket with used soiled diapers inside the facility.

Regarding the allegation: Resident's laundry needs are not being met. It’s being alleged, a resident’s bathroom consisted of piles of resident's clothing on the floor and in the sink. The investigation revealed the following. S1 & S2 both confirmed that there was an event when a resident used the facility restroom and soiled clothing was left due to the facility staff trying to clean up a resident. During interviews with residents, 2 of the 2 state that their laundry needs are met and that they don’t have any issues with the facility’s laundry
Cont 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211223160107

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN CITY HOME CARE	FACILITY NUMBER: 197607201
	VISIT DATE: 12/29/2021

NARRATIVE

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services. During interviews with witnesses, they all denied the allegation to be true. W1 states their family member’s clothing and laundry needs are met. W2 states, “I usually do surprise visits and have not had a sense that there was dirty laundry, anywhere.” W3 states, “actually no, I’m very particular about my relative and if I see something, I usually complain but I have never noticed that. I notice some pieces disappear but that’s it.” LPA did not observe any soiled laundry throughout the facility.

Based on LPA’s observation, interviews conducted, 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 allegations is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

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