197607366-12-21-2021-11-AS-MVAO-CCYVQD-20220329163809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 12/21/2021
Date Signed: 12/21/2021 03:51:47 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
10/04/2021 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211004122950

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:	02:31 PM
MET WITH:	Susana Fuentes-Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manor
Resident is being harassed by another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA spoke with Administrator Susie Fuentes via telephone prior to entering the facility to conduct risk assessment questionnaire and was informed that facility has no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff Christina Novoa. LPA explained the purposed of the visit was to deliver complaint findings and was allowed access to the facility.

The investigation consisted of the following: On 10/7/2021 LPA conducted tour of facility grounds, reviewed facility files and spoke with administrator. On 10/7/2021, 12/8/2021 and 12/9/2021 LPA Cifuentes interviewed eight residents (8) residents (R1-R8), (6) staff (S1-S6) and re-interviewed administrator. LPA requested and received the following documents: staff and client rosters and other documents pertinent to the investigation

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-20211004122950

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 handled resident in a rough manor
The complainant alleges that staff put their hands on R1 in an inappropriate manner. On 12/9/2021 LPA Cifuentes spoke with Administrator Susie Fuentes regarding the allegation. Administrator Fuentes stated she has not touched residents in a rough manner and had not seen any staff touch residents in a rough manner. LPA spoke with residents (R1-R8) regarding staff touching them/touching them aggressively and 7 out of 8 stated staff had not touched them in an aggressive or rough manner. LPA spoke with staff (S1-S6) regarding their handling of residents and 6 out of 6 staff stated they had not touched residents in a rough manner, while 5 out of 6 stated they had not seen other staff or volunteers touch residents in a rough manner.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Resident is being harassed by another resident
This allegation was addressed previously on complaint 11-AS-20211004115959 and was found to be substantiated, as there was an altercation and residents in the facility had been harassing each other. LPA is unsubstantiating this allegation as it has been addressed previously and allegation referenced the same incident.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of residents records, incident report and interviews conducted and found no evidence to support the allegations: "Staff handled resident in a rough manor”, “Resident is being harassed by another resident”.

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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