197607366-4-11-2022-11-AS-JHAD-CERNX3-20220525105029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 04/11/2022
Date Signed: 04/11/2022 03:33:04 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
04/08/2022 and conducted by Evaluator Jose Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220408111359

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: 72	DATE:	04/11/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR SUSAN FUENTES		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident not provided appointment to see onsite nurse.

INVESTIGATION FINDINGS:

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On 04/11/2022 around 09:00 AM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted at the facility with Administrator Susan Fuentes.

The Investigation consisted of the following: On 04/11/2022 LPA Calderon interviewed (R1) for complaint. On 04/11/2022 LPA Calderon received and reviewed needs and services plan, physician report, nurse notes and doctors name for (R1), staff and resident rosters for facility. On 04/11/2022 LPA Calderon interviewed S1-S5 for complaint and on 04/11/2022 LPA Calderon interviewed R1-R8 for complaint. LPA Calderon and Administrator (S1) conducted a tour of the physical plant, no issues were found.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

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-20220408111359

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: 04/11/2022

NARRATIVE

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Allegation: Resident not provided appointment to see onsite nurse.

It is alleged “Resident not provided appointment to see onsite nurse.”. On 04/11/2022 LPA Calderon interviewed resident 1 for complaint who states R1 has not been able to see R1 nurse for R1 diabetes or heart failure in 2022 and that R1 has called R1 doctor’s office and was told to call the facility med tech for more information. R1 states that R1 has not been told or given any information as to when the nurse will be coming or when R1 can see the nurse. On 04/11/2022 LPA Calderon received and reviewed needs and service plan and physician report for R1 the medical records state that R1 has mild cognitive impairment, heart failure, and is diabetic. Administrator states that there are four doctors that visit the facility and the clients that they served and reviewed medical records that state that the doctors nurse W1 has seen R1 every month in 2021 and 2022. On 04/11/2022 LPA Calderon interviewed S1 who stated that the facility has given R1 a 30 day notice to evict and that at no time has R1 ever been denied doctor or nurse services when R1 has requested. S1 states that resident is allowed in the med tech room due to need. On 04/11/2022 LPA Calderon interviewed S2-S5 who all state that no resident is denied access to a doctor or nurse when requested and that all resident is allowed in the med tech room with a medical need. On 04/11/2021 LPA Calderon interviewed R2-R8 for complaint all state that they are allowed access to the doctor or nurse when requested and that their medications are given in their room and they understand that no resident is allowed in the med tech room. Residents states that there is a sign on the med tech door stating no resident is allowed and only staff can enter the room. LPA Calderon spoke to Nurse (W1) who states that the medical records for R1 are correct and W1 did see R1 every month in 2021 and 2022.

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.

A telephonic exit interview was conducted with Administrator Susan Fuentes, and a hard copy was provided for records.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC9099 (FAS) - (06/04)

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