197607366-5-26-2022-11-AS-EMAZ-CHW3YD-20220902183947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 05/26/2022
Date Signed: 05/26/2022 10:23:00 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
05/19/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220519131723

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: 71	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Susana Fuentes - Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not providing adequate activities to residents.

INVESTIGATION FINDINGS:

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On 05/26/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Susana Fuentes.

The investigation consisted of the following: LPA requested and received resident roster, staff roster and other service documents on 05/26/2022. LPA interviewed staff (S1-S5) and Residents (R1-R9).

A plant inspection of the facility was conducted on 05/26/2022.

Investigation revealed:

See LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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-20220519131723

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: 05/26/2022

NARRATIVE

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Allegation: Staff are not providing adequate activities to residents.

It is alleged the staff are not providing adequate activities to residents.

Seven of nine residents stated they are encouraged to participate in activities. Resident (R7) stated (R7) chooses not to participate in activities. Seven of nine residents stated facility does provide an activities calendar in hallway. Resident (R4, R6, R8) all participated in a session on “Aroma therapy” this past Monday. Resident (R3, R6, R8, R9) stated the facility does offer “word puzzles” as an activity to residents.

Staff (S1-S5) stated they encourage all residents to participate in activities. Staff (S1-S5) stated the facility offers various types of activities each day and should the residents want to do another activity in the activity room, the resident is not denied and the resident is given their choice activity. Four of five staff stated the facility does offer “Aroma therapy” to residents. Staff (S4) stated (S4) did aroma therapy this past Monday. Staff (S1-S5) stated word puzzles are offered as an activity. Staff (S2) stated word puzzles were offered on the schedule prior but it was not a popular choice any longer so it was taken off; however, residents still do ask for word puzzles and we provide them printouts. Staff (S1-S5) stated the activities calendar is on the wall in the hallway.

LPA observed activity taking place as LPA entered the facility at 09:25 am in the activity room according to the activity calendar – chair exercises with ball toss. LPA observed activity calendar in hallway up to date with various activities listed. LPA observed activity calendar for each day of the month including morning and afternoon activities each day. LPA observed various completed decorations completed by different residents including wreaths, plant pots, door decorations during facility tour on resident’s doors. LPA heard over the loud speaker at 12:49 pm announcing the 1pm activity is “Bingo” while at the facility. LPA obtained activity “outings” log in sheet. LPA obtained copy of the current activity calendar.

Based on LPA’s interviews conducted, observation and records reviews, 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 violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC9099 (FAS) - (06/04)

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