197607366-3-18-2024-11-AS-MVAO-D3QQQ8-20240326122154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:25:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240311162032

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: 96	DATE:	03/18/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Susie Fuentes, Director		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not release residen'ts personal items upon discharge

INVESTIGATION FINDINGS:

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On 3/18/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced complaint visit to this facility. LPA was met by Director, Susie Fuentes, and explained the purpose of today’s visit.
The investigation consisted of the following:

On 3/18/24, LPA Shirley conducted interviews with the Director Susie Fuentes (S1) and Staff 2 through 7 (S2 – S7) and resident 1 through resident 9 (R1 – R9). LPA requested and reviewed copies of the following documents: Staff and Resident Rosters, resident file which contained, Resident Appraisals, Physician’s Reports, Resident Identification and Emergency Information, Appraisals Needs and Services Plan and ALW Program Individual Service Plan (ISP). LPA took pictures of contents in room 32.

The investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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-20240311162032

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GARDENA RETIREMENT CENTER	FACILITY NUMBER: 197607366
	VISIT DATE: 03/18/2024

NARRATIVE

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Allegation: Staff did not release resident’s personal items upon discharge

Resident is concerned about not being able to get their personal items back. R-1 does not know where his belongings are. On 7/19/23, LPA Felisa Shirley came to Gardena Retirement Center to take pictures of the contents in the room that was assigned to former resident and to assure that their personal belongings were still in the room that was assigned to them. LPA did take pictures and resident was informed that their items were still in the room. On 3/18/24 LPA Shirley again went to take pictures of room 32 which still contains resident’s belongings. LPA spoke with the Director who stated that R-1 can retrieve their belongings any time. R-1 called to inform the Director that his nurse Irma would be coming to get their belongings. The Director does not recall the actual date last year. The nurse never came to the facility and the Director has not received any more calls from R-1. LPA interviewed staff, staff 1 – staff 7 (S-1 – S-7). LPA asked staff, “When a resident is evicted from this facility, does staff release the resident’s personal items upon discharge?” Of those interviewed 6 out of 7 answered yes. LPA interviewed residents 1 – resident 9 (R-1 – R-9). LPA ask residents, were you ever faced with an eviction? Of those interviewed, 7 out of 9 answered, no.

Based on information gathered and interviews, LPA did not find sufficient evidence to support the allegation “Staff did not release resident’s personal items upon discharge,” therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the LIC 9099 report was provided to the Director, Susie Fuentes.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC9099 (FAS) - (06/04)

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