197607366-7-28-2026-11-AS-PMAA-DXBNT9-20260826104420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 07/28/2026
Date Signed: 07/28/2026 03:36:28 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
07/22/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260722115250

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:	07/28/2026
		UNANNOUNCED	TIME BEGAN:	08:57 AM
MET WITH:	Administrator Suzie Fuentes		TIME COMPLETED:	03:41 PM

ALLEGATION(S):

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Staff do not allow resident(s) to go on outings while in care.
Staff do not ensure resident(s) attend their medical appointments while in care.

INVESTIGATION FINDINGS:

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On 07/28/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator
Suzie Fuentes as the purpose of today’s visit was explained.

The investigation consisted of the following: On 07/29/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1(R1): Emergency ID form, pre-appraisal dated: 4/16/25, admission agreement dated: 01/13/26, capacity evaluation note dated: 06/30/26, Physicians report dated: 07/14/26, needs and service plan dated: 07/01/26, medication list, medication administration record (MAR) for 07/2026, and primary physician notes dated: 01/13/26- 07/21/26. On 07/28/26 from 9:30 am- 11 am LPA conducted Interviews

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

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-20260722115250

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: 07/28/2026

NARRATIVE

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with and Residents # 1-8 (R1-R8), and from 11:15 am-12:45 pm staff #1-4 (S1-S4), and witness #1 (W1). LPA conducted a review of R1's file.

The investigation consisted of the following:

Allegation: Staff do not allow resident(s) to go on outings while in care.
It is alleged that facility staff do not allow residents to have access to outside community resources. On 07/28/26 from 9:30am - 11 am LPA conducted Interviews R1-R8 regarding the allegation above. 7 of the 8 residents interviewed denied the allegation above. 2 of the 7 residents stated they are able to leave the facility unassisted, 5 of the 7 residents reported that they have access to the outside community but have to be accompanied by a staff member, family, friend or case worker. 1 of the 8 residents confirmed the allegation above and reported that staff do not allow resident to go out to the community whenever they want to, although resident believes they can access the outside community unassisted. On 07/28/26 from 11:15 am-12:45 pm LPA conducted interviews with S1-S4 regarding the allegation above. 4 of 4 staff denied the allegation above and reported that residents are not allowed to access the outside community alone if their physicians report indicates that resident(s) in care is unable to leave the facility unsupervised. Per 4 of 4 staff, if a resident wants to go out to the community the residents will ask the front desk if a staff member is available. LPA conducted interview with W1 regarding the allegation above, per W1 R1 is unable to access the community unassisted due to safety concerns. LPA conducted a review of R1's file. Per Physicians report dated: 07/14/26, R1 is unable to leave the facility unsupervised.

Allegation: Staff do not ensure resident(s) attend their medical appointments while in care.
It is alleged that staff did not make sure that resident(s) in care attended medical appointment with outside providers. On 07/28/26 from 9:30am - 11 am LPA conducted Interviews R1-R8 regarding the allegation above. 4 of the 8 residents interviewed denied the allegation above and reported they have outside medical providers and that their case

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20260722115250

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: 07/28/2026

NARRATIVE

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workers assist with transportation. 4 of the 8 residents reported that the facility has not refused to assist with transportation. 3 of the 8 residents having no knowledge of the allegation above as they see the in house Dr.. Additionally, 7 of 8 residents reported they have not missed any medical appointments due to facility staff. 1 of the 8 residents confirmed the allegation above and reported that facility staff and case worker are not ensuring that resident in care is attended medical appointment with outside providers. On 07/28/26 from 11:15 am-12:45 pm LPA conducted interviews with S1-S4 regarding the allegation above and reported that the facility will make transportation arrangements for residents who request it. Additionally, 4 of 4 staff reported that residents are reminded of any upcoming medical appointments that day before and the day of the appointment. LPA conducted interview with W1 regarding the allegation above, per W1 R1 does not have an outside medical provider. LPA conducted a review of R1's file. Per capacity evaluation note dated: 06/30/26, R1 does not have the capacity to make informed medical decisions. Per primary physician notes dated: 01/13/26- 07/21/26, LPA was able to confirm that R1 is receiving services from in house Dr. and R1 does not have an outside medical provider.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

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