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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 08/28/2020
Date Signed: 08/28/2020 04:22:04 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
08/13/2020 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20200813111625
FACILITY NAME:GARDENA RETIREMENT CENTERFACILITY NUMBER:
197607366
ADMINISTRATOR:AMY PRATTFACILITY TYPE:
740
ADDRESS:14741 S. VERMONT AVE.TELEPHONE:
(310) 327-4091
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY:108CENSUS: 72DATE:
08/28/2020
UNANNOUNCEDTIME BEGAN:
03:42 PM
MET WITH:Amy PrattTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are not meeting resident's care needs
Staff are not responding to call button in a timely manner
Staff are not maintaining resident's hygiene needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted via Facetime with Amy Pratt, the facilities administrator. LPA explained the purpose of this visit is to deliver findings regarding the complaints listed above.

The investigation consisted of the following: On 8/18/2020 LPA Cifuentes conducted a video call with the administrator. During the call, LPA spoke with administrator and was given a tour of facility grounds. LPA requested and received the following documents: staff roster, client roster, physician's report and needs and services plan for resident 1 (R1).
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
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-20200813111625
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: 08/28/2020
NARRATIVE
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Regarding the allegation: Staff are not meeting residents care needs

The investigation revealed the following:

On 8/18/2020 LPA Cifuentes toured facility grounds with staff via facetime and on 8/28/2020 LPA reviewed facility files.

On 8/19/2020 LPA Cifuentes interviewed residents 1 through resident 7. Of the residents interviewed 7 out of 7 stated the facility was meeting their care needs.

Staff were interviewed on 8/27/2020 and 8/28/2020. 5 out of 5 staff stated that they are meeting residents care needs.

Based on LPA’s observation, interviews conducted, and records reviewed, 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(s) did or did not occur, therefore the allegation is unsubstantiated.



Regarding the allegation: Staff are not responding to call button in a timely manner

The investigation revealed the following:

On 8/18/2020 LPA Cifuentes toured facility grounds with staff via facetime and observed that residents of facility have pull cords in bathrooms and in their rooms. On 8/28/2020 LPA reviewed facility files.

On 8/19/2020 LPA Cifuentes interviewed residents 1 through resident 7. Of the residents interviewed, one stated they did not use the call button and the other 6 stated the call button was answered timely.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20200813111625
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: 08/28/2020
NARRATIVE
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Based on LPA’s observation, interviews conducted, and records reviewed, 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(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff are not maintaining resident’s hygiene needs

The investigation revealed the following:

On 8/18/2020 LPA Cifuentes toured facility grounds with staff via facetime and on 8/28/2020 LPA reviewed facility files. Per staff, clients on the shower list receive about three showers a week, unless they request differently or there is a need for more.

On 8/19/2020 LPA Cifuentes interviewed residents 1 through resident 7. 6 of the residents interviewed said they received showers from the facility two to three times a week and those 6 also stated they felt their hygiene needs were being met.

Staff were interviewed on 8/27/2020 and 8/28/2020. 5 out of 5 staff stated that they are maintaining resident’s hygiene needs.

Based on LPA’s observation, interviews conducted, and records reviewed, 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(s) did or did not occur, therefore the allegation is unsubstantiated.



Exit interview conducted, and a copy of the report was given to Amy Pratt, Administrator.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3