197607366-7-26-2023-11-AS-MVAO-CVMQPY-20230913122131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 07/26/2023
Date Signed: 07/26/2023 12:48:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
06/02/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230602134247

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: 79	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Susana Fuentes		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff not responding to residents call for assistance.
Staff did not safeguard resident’s belongings.
Staff not allowing resident of personal phone call.
Staff refusing to allow resident to have visitor(s).

INVESTIGATION FINDINGS:

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On 06/07/23, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced 10-day complaint investigation at the facility listed above. LPA arrived at facility and was met by Susana Fuentes, Administrator, and explained the purpose of the visit was to investigate the allegations listed above and was granted access to the facility.

On 06/07/2023, the investigation consisted of the following:

During today's visit LPA conducted a tour check of the facility. LPA conducted interviews with the Administrator, Susana Fuentes (S1) staff (S2-S6) and residents (R1-R8). LPA requested and obtained copies of the following documents: Resident & Staff roster, client/resident personal property and valuables information, ID/Emergency information, physicians report, admissions agreement, incident reports, medical administration records, and appraisals/Needs and Services Plan for R1.

The investigation revealed the following:

Report contiunued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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-20230602134247

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GARDENA RETIREMENT CENTER	FACILITY NUMBER: 197607366
	VISIT DATE: 07/26/2023

NARRATIVE

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Regarding allegation #1: Staff not responding to residents call for assistance.
It was reported that the resident called for assistance and remained on the floor for 15 minutes, but no one came to assist. LPA interviewed staff S1-S6, and 6 out of 6 denied the allegation. All staff reported that the resident has never fallen while in their care. They further add that all residents have call buttons in their rooms and they respond to the residents when it is activated. LPA interviewed R1 about the alleged fall and R1 denied that the fall ever happened and stated that the staff responds when called. R2-R8 when interviewed, also stated that whenever they need assistance it is given.

Based on interviews there is insufficient evidence to support the allegation: Staff not responding to residents call for assistance. 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 allegations are Unsubstantiated.

Allegation #2: Staff did not safeguard resident’s belongings.

It was reported that the residents’ belongings were stolen by the staff (a potted plant, and pajamas). LPA interviewed staff S1-S6, and 6 out of 6 denied the allegation. S1 stated that when the resident came to the facility R1 did not have any belongings other that what R1 was wearing. S2-S6 also denied that anything has been stolen and neither R1 nor other residents have reported any theft in the facility. R1-R8 also stated when interviewed that they haven’t had any issues with theft.

Based on interviews there is insufficient evidence to support the allegation: Staff did not safeguard resident’s belongings. 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 allegations are Unsubstantiated.

Allegation #3: Staff not allowing resident of personal phone call

It was reported that staff is not allowing the resident any personal phone calls. It is alleged that S1 went into R1’s belongings while R1 was sleeping and took R1’s cell phone and then told family member that they could no longer talk to R1. LPA interviewed S1 about the allegation and S1 denied the allegation. S1 stated that the facility does not prevent anyone from talking to the residents. S1 stated that R1 had a cell phone but the facility gave it back to the family member and instructed them to use the front desk telephone to communicate with R1 because when they call, the resident always become rattled and agitated and tries to AWOL from the facility. S1 stated that R1 has tried to do this several times at all hours of the night when speaking on the cell phone. For the safety and well-being of the resident they gave the phone back to the family member and stated that they could speak to the resident whenever they wanted but they needed to call the facilities phone and they would bring the resident to the front desk.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230602134247

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GARDENA RETIREMENT CENTER	FACILITY NUMBER: 197607366
	VISIT DATE: 07/26/2023

NARRATIVE

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LPA interviewed S2-S6 about the allegation and 5 out of 5 denied the allegation. They stated that at no time are they preventing anyone from speaking to any of the residents. LPA interviewed R1-R8, and 8 out of 8 denied that anyone was preventing them from communicating with their family or friends.

Based on interviews there is insufficient evidence to support the allegation: Staff not allowing resident of personal phone call. 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 allegations are Unsubstantiated.

Allegation #4: Staff refusing to allow resident to have visitor(s).

LPA interviewed S1-S6 about the allegation that the staff were not allowing the resident to have visitors. 6 out of 6 staff denied the allegation and stated that all residents are allowed visitors between the hours of 10am-6pm every day. LPA interviewed R1-R8, and 8 out of 8 denied the allegation. They all confirmed that they did not have a problem with visiting friends and family.

Based on interviews there is insufficient evidence to support the allegation: Staff refusing to allow resident to have visitor(s). 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 allegations are Unsubstantiated.

No deficiencies were cited during the visit.

An exit interview was conducted with Administrator, Susana Fuentes and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

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