197607366-7-3-2020-11-AS-MVAO-BRBQP4-20200708122008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 02/15/2020
Date Signed: 07/03/2020 05:25:16 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2020 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200207131011

FACILITY NAME:	GARDENA RETIREMENT CENTER		FACILITY NUMBER:	197607366
ADMINISTRATOR:	AMY PRATT		FACILITY TYPE:	740
ADDRESS:	14741 S. VERMONT AVE.		TELEPHONE:	(310) 327-4091
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	108	CENSUS: 75	DATE:	02/15/2020
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Elizabeth Chavez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility staff failed to provide adequate food service.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Pamela Bunker, conducted an unannounced complaint visit on Saturday, February 15, 2020 to gather additional information, deliver and finalize the above allegation. LPA Bunker met with Med Tech, Elizabeth Chavez and the purpose of today's visit was explained.

Investigation consisted of the following: During the course of the investigation: LPA Bunker interviewed staff on 02/13/2020 and 02/15/2020. Residents were interviewed on 02/13/2020 from 12:30 P.M. - 3:00 P.M., LPA Bunker asked questions relevant to the nature of the complaint. On 02/13/2020 at 11: 00 A.M., LPA Bunker observed residents entering the dining room for lunch. Residents were served two (2) choices of meat, teriyaki beef and homestyle meatloaf, mashed potatoes, rice, sliced dill carrots, zucchini squash, poppy seed dinner roll, strawberries and banana, and a variety of beverages, milk, water, coffee, hot tea, apple, orange, and cranberry juices. On 02/13/2020 Administrator Amy Pratt provided LPA Bunker with copies of four (4) different food menus. Administrator stated, the facility has meal options residents can select food from.
See continued LIC9099-C on page #2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2020

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 11-AS-20200207131011

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
MONTERY PARK, CA 91754

FACILITY NAME: GARDENA RETIREMENT CENTER	FACILITY NUMBER: 197607366
	VISIT DATE: 02/15/2020

NARRATIVE

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Continued LIC9099-C page #2

Staff and residents interviewed stated that residents are served three (3) meals per day plus snacks. The facility has plenty of food and a variety of food for residents to choose from.

Administrator Amy Pratt stated on 02/04/2020 one of the residents was admitted to Harbor UCLA Medical Center in Torrance, CA for general weakness and diarrhea. On 02/05/2020 resident returned back to the facility and was diagnosed with flu symptoms. Staff stated resident never complained about the food being bland and tasteless or that he is afraid of retaliation. Staff stated resident is articulate and he is not shy.
Administrator Ms. Pratt stated they provided resident with other food options. Staff stated resident want to eat soul food. Administrator Ms. Pratt stated she offered to purchase resident soul food and he did not accept, resident stated that was not necessary. Administrator stated resident is not on a modified or special diet.

Investigation revealed the following: Interviews were conducted with staff #1- #3, and residents #1- #8. Staff and residents interviewed stated that the facility has plenty of perishable and nonperishable food for residents to eat, residents are served three (3) meals per day plus snacks. Resident interviews indicating that they are offered menu alternatives, they are allowed to substitute their meals and that they are generally satisfied with the food service based on the interviews.

Administrator provided LPA Bunker with copies of the facility's food menus, resident records and physician reports.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited.

*** During the visit LPA Bunker experienced technical difficulties.***

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2020

LIC9099 (FAS) - (06/04)

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