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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 04/13/2022
Date Signed: 04/13/2022 05:28:08 PM

Unsubstantiated


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
04/06/2022 and conducted by Evaluator Don Senaha
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220406152221
FACILITY NAME:GARDENA RETIREMENT CENTERFACILITY NUMBER:
197607366
ADMINISTRATOR:SUSANA FUENTESFACILITY TYPE:
740
ADDRESS:14741 S. VERMONT AVE.TELEPHONE:
(310) 327-4091
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY:108CENSUS: DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Administrator - Susana FuentesTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Resident is not afforded a comfortable accommodation while in care.
Staff do not ensure the residents are taking universal precautions.
INVESTIGATION FINDINGS:
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On 04/13/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Susana Fuentes. The investigation consisted of the following: LPA requested and received resident roster, staff roster and other service documents on 04/13/2022. LPA interviewed staff (S1-S5) and Residents (R1-R8).

A plant inspection of the facility was conducted on 04/13/2022.

Investigation revealed:

See LIC-9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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-20220406152221
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: 04/13/2022
NARRATIVE
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Allegation: Resident is not afforded a comfortable accommodation while in care.

It is alleged the resident is not afforded a comfortable accommodation while in care.

Resident (R2-R8) stated they are given comfortable accommodations while in care here. Resident (R2-R8) stated they like it here and staff treats them good. Resident (R2-R8) stated their care needs are being met daily. Resident (R2-R8) stated they have not had any issues with loud music being played. Staff (S1-S5) stated they feel the residents are given comfortable accommodations while in care at the facility. Staff (S1-S5) stated there is not an issue with loud music. 4 out of the 5 staff stated the only music residents listen to is on their cell phones and no residents have a boom box or blue tooth speaker to play music. Staff (S1) stated there is a house rule #15 that states “Radio or televisions may not be played too loudly. QUIET TIME 8:00pm. Please be courteous. LPA obtained copies of the house rules. LPA did not observe any music playing while at the facility during the visit.

Based on LPA’s interviews conducted, observation and records reviews, 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 violations did or did not occur, therefore the allegation is Unsubstantiated

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20220406152221
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: 04/13/2022
NARRATIVE
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Allegation: Staff do not ensure the residents are taking universal precautions.

It is alleged that staff do not ensure the residents are taking universal precautions.

Resident (R2-R8) stated they are given comfortable accommodations while in care here. Resident (R2-R8) stated they like it here and staff treats them good. Resident (R2-R8) stated their care needs are being met daily. Resident (R2-R8) stated they have not had any situations that has made them feel uncomfortable for any reason. Staff (S1-S5) stated they feel the residents are given comfortable accommodations while in care at the facility. Staff (S1-S5) stated there are two (2) residents who use a catheter in care. Staff (S1-S5) stated the catheter is secured to the residents. Staff (S1-S2) stated resident (R9) did have his catheter leak by the activity room but they immediately notified maintenance who deep cleaned the furniture. Staff (S1-S5) stated if there is spillage from the catheter maintenance is notified and it is cleaned immediately. Staff (S5) stated staff (S5) continuously looks to check the catheter and if staff (S5) feels it needs a change then staff (S5) sends the resident out to the hospital to change it.

Based on LPA’s interviews conducted, observation and records reviews, 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 violations did or did not occur, therefore the allegation is Unsubstantiated

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3