197607366-6-8-2022-11-AS-UCOL-CHS2AC-20220829171321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 06/07/2022
Date Signed: 06/08/2022 12:42:56 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
05/31/2022 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220531131957

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: 67	DATE:	06/07/2022
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Susan Fuentes		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility is not providing a comfortable environment for resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, June 07, 2022. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Susana Fuentes. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-4 (S1-S4) and residents 2-6 (R2-R6). LPA Bunker asked questions relevant to the nature of the complaint. The Administrator and staff stated the facility is providing a comfortable environment for residents in care. S1-S4 stated none of the residents is playing loud music. S1-S4 stated residents have personal rights and can listen to music on their cellphones. S1-S4 and R2-R6 stated that residents listening to music from their cellphones is not disturbing other residents. R2-R6 stated the facility staff is providing residents with a comfortable environment.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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-20220531131957

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: 06/07/2022

NARRATIVE

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Continued LIC9099-C page 2

Allegation: The facility is not providing a comfortable environment for residents in care.
Staff 1-2 (S1-S4) stated residents are provided with a comfortable environment. Residents 2-6 (R2-R6) state staff is providing them with a comfortable environment. R2-R6 stated that they do not have any issues, problems, or concerns regarding the care and supervision being provided to them by the staff. R2-R6 stated they did not have any concerns regarding residents playing music on their cellphones, and the music is not loud, nor is the volume up too loud. S1-S4 stated the residents in placement have personal rights and are allowed to listen to music on their cellphone. The residents that listen to music are not disturbing other residents.

Investigation revealed the following: Interviews were conducted with staff 1-4 (S1-S4), and residents 2-6 (R2-R6), who stated residents are provided a comfortable environment. S1-S4 and R2-R6 stated the allegation is false. S1-S4 and R2-R6 stated no one is harassing any residents. S1-S4 and R2-R6 stated residents never yelled at another resident stating that they would not turn off the music. S1-S4 stated the facility is meeting the age requirement. Residents in placement are compatible. S1-S4 states they were aware of who reported this complaint. The resident will tell them he is going to file a complaint. Staff stated the resident that reported the complaint moved out on June 01, 2022, and is still filing complaints against the facility that is not true. S1-S4 and R2-R6 all stated residents are not playing their music too loud on their cellphone and they are not turning up the volume. R2-R6 states they are happy at the facility, and the staff is providing the necessary care and supervision needed to meet resident care needs. S1-S4 stated residents are treated with dignity and respect. S1-S4 and R2-R6 all denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099, LIC9099-C, and Confidential Names LIC811 was provided to the facility Administrator Susan Fuentes.
There were no deficiencies cited. An exit interview conducted.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

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