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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/23/2022
Date Signed: 05/24/2022 09:02:30 AM

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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2022 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220131163749
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: 67DATE:
05/23/2022
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Susana FuentesTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not prevent a resident from disturbing another resident in care.
INVESTIGATION FINDINGS:
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On 5/23/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA spoke with Administrator Susie Fuentes via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms. LPA arrived at facility and explained the purposed of the visit is to investigate the allegation listed above.

The investigation consisted of the following: On 2/4/2022 LPA Cifuentes conducted a tour of facility grounds and reviewed records for staff and residents. On 2/4/2022 and 5/23/2022 LPA conducted interviews with staff (S1-S8), and residents (R1-R6). LPA Cifuentes requested and received the following documents: Client roster, staff roster and other documentation relevant to the investigation.
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: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
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 2
Control Number 11-AS-20220131163749
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: 05/23/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff did not prevent a resident from disturbing another resident in care.

The complainant alleges that facility residents are yelling and playing loud music and when it is reported to staff, nothing is done about it. LPA Cifuentes interviewed residents (R1-R6) and of those interviewed, 4 out of 6 stated the facility residents are not loud so they have had no need to report anyone to staff. LPA interviewed staff (S1-S8) regarding the allegation. Of those interviewed 7 out of 8 stated facility residents don’t normally play loud music or speak loudly. One staff further added that the times it has occurred, the resident was asked to turn down the music and self corrected after..

Based on information gathered, the department did not find sufficient evidence to support allegations " Staff did not prevent a resident from disturbing another resident in care.” 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 the LIC 9099 was provided to Administrator Susie Fuentes.

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

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2