197607366-5-25-2021-11-AS-EMAZ-C57U6K-20210723151828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/25/2021
Date Signed: 05/25/2021 03:56:10 PM

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
05/21/2021 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210521085230

FACILITY NAME:	GARDENA RETIREMENT CENTER		FACILITY NUMBER:	197607366
ADMINISTRATOR:	AMY PRATT		FACILITY TYPE:	740
ADDRESS:	14741 S. VERMONT AVE.		TELEPHONE:	(310) 327-4091
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	108	CENSUS: 65	DATE:	05/25/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Alejandra Mendoza-Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Food is not of good quality or quantity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced complaint investigation at above facility. LPA arrived at facility at 9:30 and was greeted by administrator Alejandra Mendoza. LPA explained the purposed of the visit was to investigate the allegation listed above and was granted access to the facility.

The investigation consisted of the following:

On 5/25/2021 LPA Cifuentes conducted a tour of facility grounds. Tour consisted of lounge area, kitchen, dining room, front lobby, several resident rooms, bathrooms, and activity room. LPA interviewed Administrator Alejandra Mendoza, Resident 1-Resident 6 (R1-R6) and Staff 1-Staff 5(S1-S5). LPA requested and received the following documents: staff and client rosters, facility menus, ID and Emergency information as well as nutrition information for R1-R3.
Cont on 9099-C

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: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

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-20210521085230

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: 05/25/2021

NARRATIVE

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Regarding the allegation: Food is not of good quality or quantity.

The investigation revealed the following:

On 5/23/2021 from 9:50am to 10:15am LPA Cifuentes reviewed facility dining menu. Facilities dining menu changes weekly and offers at least two entrée choices for lunch and dinner. The menu changes every week. Facility also has a Japanese food menu available at lunch, which offers a third entrée choice. If residents do not wish to eat one of the entrees on the menu, facility also provides an a la carte menu with a variety of salads, sandwiches and other foods. LPA reviewed facility records from 1:00 to 1:30pm.

On 5/23/2021 from 12:00 to 1:00pm LPA Cifuentes toured facility grounds. LPA viewed food supply and found a two-day supply of perishable and a seven day supply of non-perishable foods. LPA was also able to observe residents eating lunch and observe portions given to them.

On 5/23/2021 at 10:15am LPA Cifuentes interviewed administrator Alejandra Mendoza. Per Administrator Mendoza, residents receive 3 meals a day plus a snack at 8pm. If a resident is still hungry after they have finished their meal, they can ask for seconds. Residents are also able to ask for snacks and if there are changes they would like to see, they can bring them up to the Dietary Manager, who manages the kitchen and the food ordering. If a resident wants a large supply of a snack food or other item, facility staff will help them order it or contact their family to get it for them.

On 5/25/2021 from 11:00am-1:00pm LPA Cifuentes interviewed resident 1 -resident 6. LPA asked residents if they believed they were receiving enough food at meals and for snacks. 3 out of 6 residents stated they received enough food at meals, with a fourth stating they stocked up on snacks. When asked about the quality of the food, 4 out of 6 residents stated the food was good.

On 5/25/2021 from 10:15am to 1:00pm LPA Cifuentes interviewed staff 1-5. When asked if they believed residents received enough food, 5 of the 5 staff members stated yes.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. 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.

An exit interview was conducted, and a hard copy left with administrator Alejandra Mendoza.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

LIC9099 (FAS) - (06/04)

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