197607366-10-4-2021-11-AS-MVAO-C9BTJT-20211202134651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 09/15/2021
Date Signed: 10/04/2021 03:34:41 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
08/09/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210809161903

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: 69	DATE:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Susie Fuentes-Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident is malnourished.
Staff sexually abused resident.
Resident is being physically abused while in care.
Staff administered incorrect medication to resident.
Resident's hygiene needs are not being met.

INVESTIGATION FINDINGS:

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On 9/15/21, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to conduct interviews ans deliver findings for the allegations listed above.

The investigation consisted of the following: On 8/10/2021 LPA Cifuentes inspected the facility. LPA reviewed records for residents 1-5 (R1-R5) along with the current staff/resident roster and other documents in association with the allegations. On 9/15/2021 LPA interviewed Administrator Susie Fuentes. Interviews were conducted with five (5) staff (S1-S5) and (6) residents (R1-R6).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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 4

Control Number 11-AS-20210809161903

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: 09/15/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Resident is malnourished

The complainant alleges that facility allowed for self-neglect of resident with food which led to malnutrition. LPA reviewed admissions agreement page 7 which states facility will provide residents with three nutritionally and well-balanced meals per day with snacks available and modified diets available if prescribed by physician as medically necessary. Administrator confirmed that residents are served three meals as well as snacks a in the morning, afternoon and evening. LPA interviewed residents (R1-R6) and of those interviewed, 6 out of 6 stated they are receiving enough food for their needs. LPA interviewed staff (S1-S5) who stated that residents are getting enough food.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff sexually abused resident

The complainant alleges facility staff are sexually abusing resident. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated that there have been no reports from staff or residents of inappropriate touching. Staff in-service was conducted regarding over the counter medications and the need for doctors’ notes. LPA spoke with residents (R1-R6) regarding inappropriate touch by staff or residents. 6 out of 6 residents stated they have not been touched inappropriately. LPA spoke with staff (S1-S5), all five staff stated they had not touched anyone inappropriately nor had they seen residents do so.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210809161903

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: 09/15/2021

NARRATIVE

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Allegation: Resident is being physically abused while in care

The complainant alleges resident was physically abused by staff and roommates. LPA spoke to administrator who stated she has not been told of staff or residents physically abusing residents. LPA Cifuentes has received no SIR’s regarding physical abuse between residents or staff on residents in the past months. LPA interviewed residents (R1-R6) about physical abuse and 6 out of 6 stated they had not been hit or pinched by residents or staff. LPA interviewed staff (S1-S5) about physical abuse and was told by 5 out of 5 staff that they had not physically abused residents nor had they seen anyone physically abuse residents.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff administered incorrect medication to resident

The complainant alleges that resident was given wrong medication. On 9/15/2021 LPA reviewed facility MAR for several residents and did not find any discrepancies. Per Administrator Fuentes, facility is giving residents medications as prescribed by doctor and she has had no reports of issues with medication. LPA interviewed residents (R1-R6) about their medications and 6 out of 6 stated they had received their medications daily at the times it should be given . LPA interviewed staff (S1-S5) about medications and was told by 5 out of 5 staff that they had seen staff administer medications to clients daily and at the correct times.

Based on information gathered through observation, the Department did not find sufficient evidence to support the allegation mentioned above.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20210809161903

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: 09/15/2021

NARRATIVE

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Allegation: Resident’s hygiene needs are not being met.

The complainant alleges that facility allowed resident to self neglect as she was not assisted with personal hygiene. On page 19 of admissions agreement for resident 7 (R7) it states that assistance with activities of daily living, which includes showering and toileting, is part of basic services that resident signed up for. LPA spoke to Administrator Susana Fuentes, who stated residents are on a shower schedule and those in need of assistance with incontinence are also on a schedule to be checked on regularly. If it is reported that a resident refused a shower, administrator, medtech or office manager verify the refusal of assistance with the resident. R7 was receiving assistance with bathing but not incontinence care. LPA Cifuentes confirmed that R7 is on the shower schedule. LPA interviewed residents (R1-R6) about their hygiene needs. 4 out of 6 stated they received assistance with bathing and that they are given showers twice a week. 1 resident stated they received assistance with incontinence needs and believed staff checked hourly, but that they also pushed the button to get assistance. LPA interviewed staff (S1-S5) about resident hygiene needs and and was told by 5 out of 5 staff that residents are showered twice weekly and that when it comes to incontinence care it depends on the resident, but they are checked several times a day.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegation: “Resident is malnourished”, “Staff sexually abused resident,” “Resident is being physically abused while in care,” “Staff administered incorrect medication to resident,” “Resident’s hygiene needs are not being met”.

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.

An exit interview was conducted with Susie Fuentes and a copy of the report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC9099 (FAS) - (06/04)

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