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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607430
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:24:46 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
07/18/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20240718153153
FACILITY NAME:COMFORT HOME FOR ELDERLYFACILITY NUMBER:
197607430
ADMINISTRATOR:SOCORRO TRINIDADFACILITY TYPE:
740
ADDRESS:2729 WESTWOOD BLVD.TELEPHONE:
(310) 470-7302
CITY:WESTWOODSTATE: CAZIP CODE:
90064
CAPACITY:6CENSUS: 4DATE:
07/25/2024
UNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:SOCORRO TRINIDATIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Uncleared staff working in facility.
Unqualified staff providing care to residents.
INVESTIGATION FINDINGS:
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On 07/25/24, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. Upon arrival at the facility LPA called the facility. LPA was granted access and allowed to enter the facility to conduct the inspection. Later on, LPA was joined by the administrator Socorro Trinidad. LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed staff #1-#3 (S1-S3) and residents #1-#2 (R1-R2). LPA asked questions relevant to the nature of the complaint. A toured the facility inside to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. LPA requested, reviewed, and collected Personnel Records for four Staff (4) members (S1-S4).

Evaluation Report continues LIC 9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
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 3
Control Number 11-AS-20240718153153
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: COMFORT HOME FOR ELDERLY
FACILITY NUMBER: 197607430
VISIT DATE: 07/25/2024
NARRATIVE
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Allegation: Uncleared staff working in the facility.

The details of the complaint reported that staff employed at this facility do not have background clearance and are not cleared to work. The complainant stated there are undocumented staff that are working at the facility without US Citizenship. LPA Richard reviewed and audited personnel records for the staff #1-#4 (S1-S4), revealing that 4 out of 4 staff members have a Community Care Licensing (CCL) Criminal Background Clearance on file at the facility. On 07/23/2024, LPA ran a Facility Personnel Report Summary LIS-536 or California Department of Social Services (CDSS). The report showed all the staff were cleared. LPA interviewed the licensee (S1). Licensee stated that all the staff she hired were from referral; however, she ensured all the staff criminal backgrounds were done entirely before hiring them. Based on the information gathered, the allegation listed above is not supported.

Based on record reviews and interviews, there is insufficient evidence to support the allegation that uncleared staff working at the facility. Although the allegation may have happened or is valid, there’s not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Continued LIC9099-C page 2

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240718153153
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: COMFORT HOME FOR ELDERLY
FACILITY NUMBER: 197607430
VISIT DATE: 07/25/2024
NARRATIVE
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Allegation: Unqualified staff providing care to the residents.

The details of the complaint stated that unqualified staff are providing care to the residents. The complainant reported that the staff doesn't know CPR. Interviews conducted with three staff (S1-S3) members revealed that 3 out of 3 staff members have completed all the required medical training to help take care of the residents. The records reviewed on 07/25/2024 showed that the staff had a copy of the CPR/AED First Aid Certificate and forty hours of training on file. LPA verified training certificates and training logs were up to date. Interviews with two residents #1-#2 (R1-R2) 2 out of 2 stated that they do not have any concerns of the care or supervision the staff provided to them. Due to their health condition, (R3-R4) were not interviewed. Based on the gathered information, the allegation mentioned above is not supported.

Based on interviewed and records reviewed, there is insufficient evidence to support the allegation that unqualified staff providing care to residents. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview conducted with Socorro Trinidad and copy of the report provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3