197607366-5-31-2022-11-AS-MVAO-CFMM8R-20220622092335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/31/2022
Date Signed: 05/31/2022 03:46:18 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220209113243

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: 69	DATE:	05/31/2022
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Susana Fuentes		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for resident in care
Staff refused to let resident back in the facility

INVESTIGATION FINDINGS:

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On 5/31/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA called and spoke to administrator Susana Fuentes and was told the facility has no current COVID-19 cases nor do any of the staff or residents show any signs or symptoms. LPA arrived at facility and was greeted by Office Manager Christina Novoa. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted entry.

The investigation consisted of the following:
On 2/17/2022 LPA Cifuentes toured facility grounds and viewed facility files. LPA interviewed staff 1-staff 6 (S1-S6) and residents 1-resident 6 (R1-R6). LPA Cifuentes requested and received a staff roster, resident roster and other documents relevant to the allegations.

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: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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-20220209113243

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: 05/31/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff did not seek timely medical attention for resident in care

It is alleged that facility staff denied resident medical attention and they had to call 911 themselves. LPA Cifuentes spoke with administrator and several staff regarding incident. Per staff R1 arrived at facility very agitated and was screaming threats against residents and then stating they had been poisoned. Staff asked them to calm down and called 911, the police arrived within five minutes and called ambulance to have resident taken to hospital. LPA spoke with residents (R1-R6) regarding the allegation. LPA asked residents if they had ever been denied medical attention by staff. Of those interviewed, 3 answered no, 1 said yes, 1 did not answer and 1 was unsure. LPA spoke with staff (S1-S6) regarding allegation. LPA Cifuentes asked staff if they had ever denied a resident medical attention. Of the staff questioned, 5 out of 6 answered that medical attention was not denied to residents.

Based on information gathered, the department did not find sufficient evidence to support allegation " Staff did not seek timely medical attention for resident in care

Allegation: Staff refused to let resident back in the facility.

It is alleged that facility staff refused to let resident back into facility. LPA interviewed administrator Susie Fuentes who stated residents had not been denied reentry to facility. There was an incident with a resident returning, who was very agitated, screaming and yelling threats as well as saying they were poisoned. As there was a safety concern, staff called 911 and tried to calm the resident. LPA interviewed residents regarding allegation and of the residents interviewed 4 out of 6 stated they had not been denied entry to the facility. Of the staff interviewed, 5 out of 6 said residents had not been denied entry to the facility with 1 being unsure.

Based on information gathered, the department did not find sufficient evidence to support allegation “Staff refused to let resident back in the facility.”

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegations: " Staff did not seek timely medical attention for resident in care “Staff refused to let resident back in the facility

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 hard copy 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: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC9099 (FAS) - (06/04)

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