197607366-3-10-2022-11-AS-EMAZ-CCT24A-20220323170336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 03/10/2022
Date Signed: 03/10/2022 04:20:24 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
12/17/2021 and conducted by Evaluator Elizabeth Ceniceros

COMPLAINT CONTROL NUMBER: 11-AS-20211217144410

FACILITY NAME:	GARDENA RETIREMENT CENTER		FACILITY NUMBER:	197607366
ADMINISTRATOR:	SUSANA FUENTES		FACILITY TYPE:	740
ADDRESS:	14741 S. VERMONT AVE.		TELEPHONE:	(310) 327-4091
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	108	CENSUS:	DATE:	03/10/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Susana Fuentes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Smoke alarms are in disrepair.

INVESTIGATION FINDINGS:

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On 03/10/22 at 3:00 p.m. Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros, conducted a subsequent complaint investigation visit regarding the above-mentioned allegation. LPA Stephanie Cifuentes conducted the initial 10-Day visit on 12/21/21. LPA/RA Ceniceros was already present conducting another subsequent visit (Complaint Control #11-AS-20211216155411). LPA/RA Ceniceros spoke with Administrator Susana Fuentes at 3:00 p.m. and explained the purpose of today's visit.

The investigation consisted of the following: LPA/RA conducted interviews with (9) facility staff and (7) residents and attempted (1) resident. LPA/RA Ceniceros and Administrator Fuentes conducted an inspection of the facility’s physical plant for health and safety measures; observed the facility's wired smoke detectors & fire alarms, fire extinguishers meets regulations, posted "Exit" signs throughout the facility and Emergency Evacuation Routes for the 1st and 2nd floors; records review: fire alarm system inspection & test report

(Report continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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-20211217144410

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: GARDENA RETIREMENT CENTER	FACILITY NUMBER: 197607366
	VISIT DATE: 03/10/2022

NARRATIVE

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(dated 02/08/22), cosco wet pipe fire sprinkler inspection, testing, and maintenance report (dated 02/08/22), emergency light & exit sign inspection & test report (dated 02/08/22).

Allegation: Smoke alarms are in disrepair.

The complaint alleges that two (2) smoke detectors situated in the hallway (over the fire doors) have been beeping for two (2) weeks. LPA/RA Ceniceros toured the facility and videotaped the wired smoke detectors located in the hallway above the fire doors and did not hear the sound of beeps from their direction. LPA/RA spoke to Staff #1 (Maintenance Director, Carlos Aguirre) who indicated that the facility has a wired fire alarm system with smoke detectors throughout the facility. LPA/RA Ceniceros spoke with residents (R1-R7) in regards to smoke detectors being in disrepair; and, the majority stated he/she had not noticed beeping sounds coming from the smoke detectors. LPA/RA Ceniceros spoke with facility staff (S1-S9) regarding the smoke detectors in disrepair; and, the majority had not heard the smoke detectors to be inoperable with beeping sounds.

Based on information gathered through interviews, observations, and records review, the Department did not find sufficient evidence to support the allegations mentioned above.

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 and a copy of this report was provided to Administrator Susana Fuentes.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC9099 (FAS) - (06/04)

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