197607366-5-19-2022-11-AS-MVAO-CFMQEE-20220622120613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/19/2022
Date Signed: 05/19/2022 04:14:21 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
02/17/2022 and conducted by Evaluator Gail Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220217133251

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:	05/19/2022
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Susana Fuentes		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not respond to resident's call button in a timely manner.

INVESTIGATION FINDINGS:

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On 05/12/22, Licensing Program Analyst (LPA) Gail Johnson and Licensing Program Manager (LPM) Eva Alvarez conducted a subsequent unannounced complaint visit. LPA Johnson and LPM Alvarez met with Administrator Susana Fuentes and explained the purpose of today's visit.

Investigation consisted of:

LPA Johnson conducted interviews with Administrator Fuentes, Staff (S1) – (S3) and Residents (R1), (R3), (R4), (R5), (R6), and (R7). LPA Johnson obtained copies of the staff training on 03/10/22 in Recognizing Residents’ Needs and Communication Expectations, Staff roster, and Resident Roster, (R1)’s Admission Agreement, (R1’s) Appraisal/ Needs and Services Plan, and (R1’s) Physician’s Report.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Gail Johnson	TELEPHONE: (626) 228-4917
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

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-20220217133251

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: 05/19/2022

NARRATIVE

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Investigation revealed:

Allegation - Staff did not respond to resident's call button in a timely manner.

Based on the review of records and interviews conducted, LPA found that the call button is used for all types of needs. The facility call button and alert system is used for emergencies and non-emergencies. When a resident uses the call button, the front desk receives an alert and responds to the resident through their room intercom immediately. Once the alert is received at the front desk, a caregiver is called on a transceiver (two-way radio). The caregiver notifies the front desk of the time frame that they will arrive at the resident’s room. The front desk then calls the resident on the intercom system and communicates the wait time to the Resident. If the Resident reports an urgent (Emergency) need by call button, a Staff member reports to the Resident room without delay. Based on interviews conducted, six (6) of six (6) Residents stated not having any call button response concerns or knowing of any Residents speaking of call button response concerns. LPA conducted interview with (R1), who stated not having used the call button since moving into the facility and commented, “I need assistance but not like that.”

LPA conducted interviews with Administrator Fuentes and Staff (S1) – (S3), who stated that staff respond immediately when a call from the resident is placed, and the residents are informed of approximate wait time if Caregivers are providing assistance to other Residents. Staff state an average wait time is 5 - 15 minutes. The front desk notifies the resident on the intercom If the wait will take more than 15 minutes. Staff (S1) – (S3) stated, the front desk always remains consistently staffed to attend the call alert system and supervise the lobby area for safety purposes. When Staff need to leave the front desk, they wait for another Staff member to arrive before leaving.

Although the allegation 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.

A copy of this report was given to Administrator Susana Fuentes.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Gail Johnson	TELEPHONE: (626) 228-4917
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2022

LIC9099 (FAS) - (06/04)

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