197607366-7-8-2024-11-AS-EMAZ-DBY2RS-20241214163758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 07/08/2024
Date Signed: 07/08/2024 02:41:45 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
06/24/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20240624161033

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: 90	DATE:	07/08/2024
		UNANNOUNCED	TIME BEGAN:	10:04 AM
MET WITH:	Susana Fuentes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not allow visitors to visit resident.
Staff are not suppling hygiene products to resident.
Staff are not providing food to resident.
Staff hit resident.
Staff are not assisting resident in the shower.

INVESTIGATION FINDINGS:

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On 07/08/2024, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings regarding the above allegations. LPA met with administrator Susana Fuentes.

The investigation consisted of the following. On 07/02/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an annannounced complaint visit. LPA met with the administrator, Susana Fuentes and explainted the purposed of today's visit and was granted entry.
During today's investigation, LPA toured the facility inside and out and requested copies of the staff roster, resident roster, and residents' files. LPA also reviewed records, interviewed 8 residents and 6 staff members, and obtained documents. Due to time constraints, the above allegations need further investigation. On 07/08/2024, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings regarding the above allegations.

Report Continues, See LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

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 6

Control Number 11-AS-20240624161033

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: 07/08/2024

NARRATIVE

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Continued LIC9099-C Page 2

Allegation #1: Staff do not allow visitor to visit resident.

The details of the complaint alleged that the staff are not allowing the resident to have visitors. LPA interviewed the administrator Susana Fuentes (A1) denied the allegation. A1 stated that all the residents have visitors seven day a week. The residents if they share rooms, they could not have visitors inside the room, unless it’s a private room. The residents can have visitors on the front porch, and in the back in the patio with the gazebo. LPA interviewed the Business Office Manager (BOM 2) stated that most of the residents have visitors and they most sign in and out. Sometimes the family members call the front desk to reserve the patio with the gazebo for the residents if they are going to have more than 4 to 6 visitors that day or to celebrate a special occasion. LPA interviewed eight residents (R1-R8) 7 out of 8 stated that they do have family members visited them, they all know if you have a roommate, you cannot have visitors inside your room unless the roommate agrees to let your visitors come inside the room. The residents (R2-R8) and staff (S1-S2) all denied the allegation. Records reviewed showed that resident have visitors at the facility on 06/01/2024 through 06/29/2024. During the visit to the facility on 07/02/2024, LPA observed several family members visiting the residents outside on the porch and the patio.
Based on interviews, observation, 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.

Continued LIC9099-C page 3

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 11-AS-20240624161033

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: 07/08/2024

NARRATIVE

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Continued LIC9099-C page 3

Allegation #2: Staff are not suppling hygiene product to resident.

The details of the complaint alleged that the staff are not giving hygiene products.
LPA interviewed the administrator Susana Fuentes (A1) denied the allegation stated that the facility does not provide hygiene needs to the residents, however when the resident comes and asks the staff to provide them hygiene because they run out the staff will provide the residents with the supplies until the family bring them their hygiene supplies. LPA interviewed six staff (S1-S6) 6 out of 6 stated that is very seldom a resident would ask them for hygiene products. LPA interviewed eight residents (R1-R8) 8 out of 8 residents stated that they bought their own hygiene products, sometimes they might miss one or two things, however the staff does provide them the items. LPA interviewed R1, and R1 stated that the cabinet in R1’s room was full of hygiene products, LPA confirmed. R1 also stated that the staff would give some items when R1 run out. A review of the resident’s admission agreement on 07/02/2024 indicated that residents and their families are responsible for their hygiene products. The residents (R1-R8) 8 out of 8 and staff (S1-S6) 6 out of 6 denied the allegation.
Based on interviews, observation, 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.

Continued LIC9099-C page 4

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20240624161033

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: 07/08/2024

NARRATIVE

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Continued LIC9099-C page 4

Allegation #3: Staff are not providing food to the resident.

The details of the complaint alleged that staff are not providing food to resident. The department interviewed the Administrator#1 (A1) stated that residents are provided with a variety of quality food to eat. Staff (S1-S6) 6 out of 6, and Residents (R1-R8) 8 out of 8, all stated the residents receive enough food, and vegetable, including three (3) meals, breakfast, lunch, and dinner. The Administrator stated that the staff serves a well-balanced meal with a variety of food option to choose from each day. The department interviewed six staff (S1-S6) 6 out of 6 who stated that the food menu changes daily, and residents can select something different if they prefer. The department interviewed eight residents (R1-R8) 8 out of 8 stated that they had no issues with the food. Sometimes, they like to order food outside the facility. On 07/02/2024, the department observed the residents (R1-R8) 3 out of 8 ordering food from the outside stated they wanted to eat a different type of food for lunch that day. On 07/02/2024, the department reviewed the facility menu for the week and observed a variety of food options listed on the menu.

Based on the interviews, 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.

This report serves as an amendment to clarify lines number 15, 16, 17 and 18. It does not supersede the complaint investigation findings reflected in the report created on 07/08/2024.

Continued LIC9099-C page 5

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20240624161033

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: 07/08/2024

NARRATIVE

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Continued LIC9099-C page 5

Allegation #4: Staff hit resident.

The details of the complaint alleged that resident is being hit by staff. During today’s visit, the administrator (A1) stated that the staff would not hit any residents, that would result in firing the staff. LPA interviewed six staff, and (S1-S6) 6 out of 6 stated that they would not hit or mistreat any resident at the facility. Staff (S2-S3) stated that they have been hit in the face by residents, and they are now going to physical therapy. LPA interviewed eight residents, and (R1-R8) 8 out of 8 stated that they had not been physically or hit by any staff at the facility. The residents denied the allegation and stated that staff hitting the resident did not happen.
Based on the interviews, 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.

Allegation #5: Staff are not assisting resident in the shower.

The details of the complaint alleged that the staff is not assisting residents in the shower resulting in residents falling in the shower. During today’s visit, the administrator (A1) stated that the staff would assist residents in the shower because every resident in a wheelchair has a daily incontinence, and shower schedule. LPA interviewed six staff (caregivers) (S1-S6) 6 out of 6 stated that they would assist residents in the shower by bathing them.

Continued LIC9099-C page 6

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20240624161033

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: 07/08/2024

NARRATIVE

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Continued LIC9099-C page 7

LPA interviewed eight residents, (R1-R8) and 8 out of 8 stated that the staff does help them shower. LPA interviewed R1, R1 stated that R1 had no problems with the showers. R1 noted that the staff had not let R1 fall in the shower. R1 also stated that sometimes R1 refused to shower if the assigned caregiver was not working that day because R1 likes the way R1 regular caregiver assists R1 with daily showers. All the residents denied the allegation that the staff were not assisting resident in the shower resulting in resident falling in the shower, did not happen. During the record review, no SIRs of any resident falling in the shower occurred.
Based on the interviews, 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.

There were no deficiencies cited. Exit interview conducted.

A copy of the Complaint Investigation Report LIC9099-C and LIC9099C were provided to the Administrator Susana Fuentes.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

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