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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/31/2022
Date Signed: 05/31/2022 03:49:35 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-20220209154559
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: 69DATE:
05/31/2022
UNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Susana FuentesTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is not preventing the spread of COVID-19.
Resident's are confined to their bedrooms.
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, reviewed facility files and interviewed staff 1-staff 6 (S1-S6) and residents 1-resident 6 (R1-R6). LPA requested and received the following: Staff roster, resident roster and other documents in association with the alelgations.
Continued on 9099-C
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: 05/31/2022
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)
Page: 1 of 3
Control Number 11-AS-20220209154559
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: Facility is not preventing the spread of COVID-19.

It is alleged that facility staff were not following covid-19 protocols during recent outbreak. LPA Cifuentes toured facility on 2/17/2022 and noted the following: Facility has one main entry. Upon entry to the facility LPA’s temperature was checked, they were asked to use hand sanitizer and fill out a sign in sheet which asked temperature and screened LPA for covid-19 symptoms. LPA noted sanitizer stations and hot water and paper towels were located in public bathrooms. LPA Cifuentes was shown to room 22, which had PPE supplies and had donning and doffing posting in both English and Spanish posted. Per Administrator Fuentes, facility was conducting weekly testing, cleaning high touch surfaces every 30 minutes and cleaning rooms of positive residents daily. Residents in red and yellow zone were kept in isolation with meal and medication delivery to rooms. There was a specific designated staff person who entered the isolated residents’ rooms, they took their breaks outside and had a designated bathroom. Residents were asked to maintain social distancing at the time and wear face masks when exiting rooms. Facility also suspended eating in dining room after the New Year and had tray service for the residents until outbreak numbers dropped. LPA spoke with residents (R1-R6) regarding the allegations. LPA asked residents if staff wore PPE while in the red zone, or those interviewed, 1 refused to answer, 2 stated they did not know, 2 said yes, and 1 answered no. LPA spoke with staff (S1-S6) regarding allegations. LPA Cifuentes asked staff if they had received PPE training, if they or those assigned to isolation area were properly donning and doffing PPE when entering isolation rooms and if isolation rooms in the red zone remained closed. Of the staff questioned, 6 out of 6 answered yes to all questions.

Based on information gathered, the department did not find sufficient evidence to support allegation " Facility is not preventing the spread of COVID-19.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (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)
Page: 2 of 3
Control Number 11-AS-20220209154559
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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Allegation: Residents are confined to their bedrooms.

It is alleged that facility staff is confining residents to their bedrooms. On 1/21/2022 LPA Cifuentes was contacted by Administrator Susana Fuentes who informed LPA that facility was conducting weekly Covid-19 tests as a preventive measure and that the latest test results showed facility had several residents test positive for Covid-19. Public health was also contacted. LPA checked in with Administrator Fuentes during outbreak and was told that despite contacting the local Public Health department, they had not received any contact in return. To prevent the further spread of Covid-19 in the facility and due to the length of time it was taking to get test results back from laboratories, Administrator Fuentes ceased communal dining and group activities until the transmission could be contained or other direction was received from Public Health but stared that some residents still chose to leave their rooms and although staff offered redirection, they could not prevent them from going out. Per PIN 21-49-ASC, which was released on 11/17/2022, Residents not in isolation or quarantine maintained the right to participate in communal dining and group activities, but during an outbreak at the facility, the local department of public health could require a cessation of all communal activities until transmission could be contained. LPA interviewed residents regarding allegation and of the residents interviewed 5 out of 6 stated they wore masks out of the rooms during the quarantine. Of the staff interviewed, 5 out of 6 said yes when asked if the residents wore masks outside of their rooms during the quarantine.

Based on information gathered, the department did not find sufficient evidence to support allegation “Resident's are confined to their bedrooms.”

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: "Facility is not preventing the spread of COVID-19,” “Resident's are confined to their bedrooms.”.



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
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (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)
Page: 3 of 3