197607366-8-25-2021-11-AS-EMAZ-C7LVJ5-20211008162807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:55:35 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
06/29/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210629115913

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:	DATE:	08/25/2021
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Susana Fuentes		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff is interfering with the residents hygiene needs
Staff is not administering medications as needed
Staff is not providing transportation services for the residents
Staff is not providing comfortable accommodations for residents while in care
Staff threatened a resident with eviction
Staff are not properly providing care and supervision to the residents while in care

INVESTIGATION FINDINGS:

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On 08/25/21, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to deliver findings for the allegations listed above.

The investigation consisted of the following: LPA interviewed Administrator Susie Fuentes. Interviews were conducted with seven (7) staff (S1-S7) and (7) residents (R1-R7). LPA inspected the facility. LPA reviewed records for residents 1-5 (R1-R5) along with the current staff/resident roster and other documents in association with the allegations.

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: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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 4

Control Number 11-AS-20210629115913

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: 08/25/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff is interfering with the resident’s hygiene needs

The complainant alleges that administrator stopped house hygiene supplies for residents and told them that they had to purchase it on their own. Similar allegation addressed on complaint# 11-AS-20210706130137. LPA reviewed admissions agreement page 4, which states the facility will assist with the ordering of supplies and assist with personal hygiene. Administrator stated that facility provides supplies for those on the Healthy Families program but for everyone else the resident or the family is responsible to provide hygiene supplies. The facility does have a stock of donated care packages which are given to those who don’t have supplies. LPA interviewed residents (R1-R7) and of those interviewed, 7 out of 7 stated the facility did not provide hygiene supplies and 5 of those 7 indicated they could purchase it on their own. LPA spoke to staff regarding hygiene supplies and 6 out of 7 stated facility does not provide hygiene supplies.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff is not administering medications as needed

The complainant alleges facility staff have stopped given residents over the counter medications. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated that there is a house supply of over the counter medications but for those residents who requested over the counter medication a doctors ordered was needed. Staff in-service was conducted regarding over the counter medications and the need for doctors’ notes. LPA spoke with residents (R1-R6) regarding over the counter medications and 5 out of 6 residents stated facility had not been providing overt the counter medications. LPA spoke with staff (S1-S7) all seven staff stated facility was not currently giving out over the counter medications, with three of those questioned stating that a doctors order was needed.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210629115913

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: 08/25/2021

NARRATIVE

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Allegation: Staff is not providing transportation services for the residents

The complainant alleges administrator stopped Uber as transportation for residents’ medical appointments. Similar allegation addressed on complaint# 11-AS-20210706130137. LPA spoke to administrator who stated facility has Lyft account for resident’s medical transportation if they cannot use other services. Ms. Fuentes stated she has used Uber for one residents’ appointments and other residents have set-up Access transportation services, use medical transportation or Gardena transit. LPA was given copies of Uber receipts. LPA interviewed residents (R1-R7) about transportation and was told they use a variety of the following: the facility helps set up transport, Access transportation, they drive, or use public or medical transport. When asked if the facility assisted with transportation 5 out of 7 state the facility helps. LPA also asked if facility had ever refused to assist them with transportation and 4 of the 7 said no. LPA interviewed staff (S1-S7) about transportation and was told by 5 out of 7 that facility assists with transportation.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff is not providing comfortable accommodations for residents while in care

LPA noted on 7/6/2021, 8/5/2021 and 8/25/2021 that facility is clean, free of odors and in good repair. Resident rooms had appropriate amount of beds for those in residence. LPA observed enough bedding, soap and toilet paper in rooms. Of the rooms surveyed on multiple visits, all had working toilets and sinks in attached bathrooms. Facility was at a comfortable temperature, with individual rooms adjusted to resident’s preference. Facility provides a dining room, lounge, outdoor shaded area and an outdoor smoking area for all residents in care. Facilities accommodations are within title 22 regulations.

Based on information gathered through observation, the Department did not find sufficient evidence to support the allegation mentioned above.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210629115913

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: 08/25/2021

NARRATIVE

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Allegation: Staff threatened a resident with eviction

The complainant alleges that administrator told resident R2 they had to stop smoking or they would be evicted. LPA spoke to Administrator Susana Fuentes, who stated she had a discussion with R3 regarding their smoking inside of their room. Facility allows residents to smoke in smoking area, which is outside in back of the facility but does not allow smoking in doors. LPA Cifuentes spoke to R2, who stated they did smoke in the smoking area and had not been threatened with eviction. LPA spoke with six other residents, who all stated they were allowed to smoke in facilities smoking area. LPA also spoke to staff regarding residents smoking and 7 out of 7 staff stated residents are allowed to smoke outdoors.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff are not properly providing care and supervision to the residents while in care

The complainant alleges that the facility is short on staff. LPA Cifuentes addressed a similar allegation on Complaint# 11-AS-20210706130137. LPA Cifuentes substantiated that allegation but noted that today 8/25/2021 during walkthrough facility had three caregivers attending residents as well as a medtech and the activities director who can assist with care giving if needed.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegation: “Staff is interfering with the residents hygiene needs”, “Staff is not administering medications as needed”, “Staff is not providing transportation services for the residents”, “Staff is not providing comfortable accommodations for residents while in care”, “Staff threatened a resident with eviction”, “Staff are not properly providing care and supervision to the residents while in care”.

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.

An exit interview was conducted with Susie Fuentes and a copy of the report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4