197607366-2-7-2024-11-AS-RORN-D3YM9C-20240403092427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 02/07/2024
Date Signed: 02/07/2024 04:20:44 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
01/29/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240129123701

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: 87	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Susie Fuentes, Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility staff did not arrange for medical care as needed.
Facility staff did not dispense medications as prescribed.

INVESTIGATION FINDINGS:

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On 2/7/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced complaint visit to the address listed above. LPA arrived and spoke to Administrator Susie Fuentes and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following: On 2/7/24 LPA Shirley toured first floor of facility for resident interviews. LPA also requested and reviewed copies of the following records: Resident Roster, Staff roster, Physicians report, Id and Emergency Info, Preplacement Appraisal, Appraisal Needs and Services, LCD Pharmacy/Medication Info, MAR’s, Facility Agreement Form/5150 Hold, Initial Psychological Eval 4/30/21, Progress Note from PCP visit 1/16/24, Admission Agreement and SIR’s that involved resident.

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: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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-20240129123701

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: 02/07/2024

NARRATIVE

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Allegation: Facility staff did not arrange for medical care as needed

It is being reported that resident requested to be seen by a therapist. There was a new resident assigned to R-1’s room. Per RP, that is when the problems began. New roommate triggered R-1’s behaviors. R-1 would become anxious and displayed aggressive behaviors. RP stated R-1 requested to be seen by a therapist. LPA reviewed resident’s facility file and observed Initial Psychological Eval dated 4/30/21. R-1 was given numerous opportunities to be evaluated by in-house therapist. R-1 refused to be evaluated as hours were too early. R-1 was given the therapist number to call anytime to be seen. R-1 never called to schedule an appointment.

On 2/7/24 LPA Shirley interviewed resident 2 – resident 8 (R-2 - R-8). LPA asked residents, do you feel that you get the medical care that you need here. Of those interviewed, 5 out of the 8 answered yes. R-1 was not available for interview. On 2/7/24 LPA Shirley interviewed staff 1-staff 8 (S-1 - S-8). LPA asked staff, do you arrange for medical care as needed. Of those interviewed, 7 out of 8 staff answered yes.

Based on information gathered, the department did not find sufficient evidence to support allegations " Facility staff did not arrange for medical care as needed.” 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 Unsubstantiated.

Allegation: Facility staff did not dispense medications as prescribed

It is being reported that every time R-1 request anxiety medications the staff would put her off. During file review, LPA reviewed Medication Information from LCD Pharmacy prescribing anxiety medications from Dr. Pantea Farhadi, Psychiatrist. LPA called doctor to verify services for R-1. LPA was told by Dr. Pantea Farhadi that R-1 is seen monthly. LPA also reviewed the MAR for R-1 and observed that resident did not miss a dose of medication up until their last day at the facility on 1/22/24. The days following last day at facility, the MAR is initialed “H” for hospital. LPA was told by S-1 and S-3 that R-1 would arrive early for medication to be dispensed and R-1 was told to return at a specific time to be given medication as per prescribed time.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240129123701

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: 02/07/2024

NARRATIVE

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On 2/7/24 LPA Shirley interviewed resident 2 – resident 8 (R-2 - R-8). LPA asked residents, when you request prescribed medication from the staff do you usually get what you need. Of those interviewed, 6 out of the 8 answered yes. R-1 was not available for interview. On 2/7/24 LPA Shirley interviewed staff 1-staff 8 (S-1 - S-8). LPA asked staff, when a resident request prescribed medication, does the resident get the medication. Of those interviewed, 4 out of 8 staff answered yes, if prescribed. Two answered they would tell the med techs as they are caregivers and two did not know.

An exit interview was conducted and a copy of the LIC 9099 was provided to 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: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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