197607366-12-21-2021-11-AS-MVAO-CBQTXU-20220217140743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 12/21/2021
Date Signed: 12/21/2021 03:50:33 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
09/09/2021 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210909155011

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: 66	DATE:	12/21/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Susana Fuentes		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are failing to meet residents' needs
Resident wandered away while in care
Staff speak to residents inappropriately
Staff failed to provide adequate food service
Staff failed to provide a safe and comfortable environment for residents
Facility is disrepair

INVESTIGATION FINDINGS:

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12/21/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susana Fuentes, Administrator and explained the purpose of today's visit is to deliver findings for the allegations listed above.

The investigation consisted of the following: On 9/15/2021 LPA Cifuentes conducted a tour of facility grounds. LPA spoke with administrator, reviewed facility files and requested and received the following documents: staff roster, client roster and other documents relevant to the investigation. On 12/8/2021 and 12/9/2021 LPA Cifuentes interviewed staff 1 -Staff 6 (S1-S6) and Residents 1-resident 8 (R1-R8)

Continued on 9099-C

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: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

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-20210909155011

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: 12/21/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff are failing to meet residents' needs

The complainant alleges facility is failing to provide activities for the residents. Per Susie Fuentes, administrator, facility provides bingo, ball toss, dominoes. For those with dementia they have coloring and one on one time to stimulate them and they also go for walks in the park. LPA interviewed residents (R1-R8) regarding what activities the facility provides. Six of the eight interviewed residents stated facility provided bingo, ball toss, arts and crafts and outings. LPA interviewed staff (S1-S6) regarding activities provided to the residents. One staff stated they did not know, as they do are not present for activities. Of the others interviewed, 5 out of the 6 staff interviewed were able to state that the facility had activities.

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

Allegation: Resident wandered away while in care

The complainant alleges Resident 9 (R9) wandered away from the facility. LPA reviewed incident reports and did not have any reports of R9 wandering away or eloping while in care. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated no residents had eloped in her time at the facility. LPA spoke with residents (R1-R8) regarding eloping/wandering. Of those interviewed, 8 out of 8 residents stated they have not wandered away from the facility. R9 was unavailable for interview. LPA interviewed staff (S1-S6) regarding residents wandering. Of those interviewed, 4 out of the 6 staff interviewed stated that residents had not wandered from the facility. Staff stated they constantly redirected residents so they would not try and wander.

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

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210909155011

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: 12/21/2021

NARRATIVE

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Allegation: Staff speak to residents inappropriately

The complainant alleges the staff always talk to the residents inappropriately by saying that if they don’t like the facility, they will talk to their social workers and move them out to a different location. LPA spoke to administrator Susie Fuentes regarding allegation. Administrator Fuentes stated none of her staff had spoken inappropriately to residents. LPA interviewed residents (R1-R8) about staff speaking to them inappropriately or rudely to them. Of those interviewed, 8 out of 8 residents stated staff had not spoken inappropriately to them. LPA interviewed staff (S1-S6) about how they spoke to residents and was told by 6 out of 6 staff that they had not spoken rudely or inappropriately to resident.

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

Allegation: Staff failed to provide adequate food service

The complainant alleges that facilities food is creepy. LPA viewed facility food menu and food which contains a variety of meats, grains, fruits and vegetables. LPA interviewed residents (R1-R8) regarding allegation. 5 out of 8 residents interviewed stated the food was fine. One of the eight interviewed declined to comment. LPA interviewed staff (S1-S6) about the food and was told by 4 out of 6 staff that the facility food was fine and that the menu has variety.

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

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210909155011

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: 12/21/2021

NARRATIVE

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Allegation: Staff failed to provide a safe and comfortable environment for residents

The complainant alleges that facility does not provide a safe and comfortable environment for the residents. RP stated that second floor rooms have balconies which could be unsafe for Dementia Residents. LPA spoke to Administrator and several staff who stated that all residents with dementia or confusion reside on the first floor of the facility. More independent residents are housed on the second floor. LPA Cifuentes asked Administrator Susie Fuentes about the safety of the facility and providing a comfortable environment for residents. Per Ms. Fuentes, the facility is able to provide both a safe and comfortable environment for its residents. LPA interviewed residents (R1-R8) and asked if they felt safe at the facility. 7 out of 8 stated they felt the facility was safe. LPA interviewed staff (S1-S6) regarding resident safety and comfortability for residents at the facility. 4 out of 6 stated they felt the facility was safe.

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

Allegation: Facility is disrepair

The complainant alleges that facilities front door is broken. During visit on 9/15/2021 LPA Cifuentes noted that facility door was locked and had to be opened by staff to allow entry. No glass was broken, nor did it appear bent. LPA spoke to Administrator Susana Fuentes, regarding the facility door. Per Ms. Fuentes, the facility door is not broken, it was not closing on its own, it had to be pushed to close. She further added that the door has been repaired. LPA interviewed residents (R1-R8) regarding the facility door. 7 out of 8 residents stated the facility door is not broken.LPA interviewed staff (S1-S6) about the facility door being broken. Per all six staff interviewed, the facility door is not broken. A few added that it had been broken in the past but had been fixed.

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 allegations.

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: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

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