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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 07/16/2021
Date Signed: 07/16/2021 10:35:51 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210506100850
FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY:96CENSUS: 45DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Elizabeth Hernandez, Social WorkerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility door is too heavy for residents to open
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Elizabeth Hernandez, Social Worker

The investigation consisted of following: Interviews, Record reviews, and Physical inspection. On 05/17/21, LPA Soto conducted interviews with the Administrator Gwendolyn, R#1 - R#6, S#2 - S#5. The LPA also requested copies of the following documents: Resident rosters, staff roster, kitchen, face sheets, Dietary restrictions, Pre-Appraisals, Logs of delinquent payments, Menu, Resident meal substitute request form, estimate from companies to replace dining room double doors, and Physician's Report. LPA and administrator toured the kitchen, dining room, double doors, food storage, back patio, rooms 6, 19, 27, 35, 37, 42, plate of food served, activity room, med room, nurses’ station, and administrators office. LPA attempted to open the dining double doors when the were closed, LPA Soto had a really hard time trying to open the double doors.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210506100850

FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY:96CENSUS: 45DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Elizabeth Hernandez, Social WorkerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
Staff do not provide residents healthy food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Elizabeth Hernandez, Social Worker.

The investigation consisted of following: Interviews, Record reviews, and Physical inspection. On 05/17/21, LPA Soto conducted interviews with the Administrator Gwendolyn, R#1 - R#6, S#2 - S#5. The LPA also requested copies of the following documents: Resident rosters, staff roster, kitchen, face sheets, Dietary restrictions, Pre-Appraisals, Logs of delinquent payments, Menus, Resident meal substitute request form, estimate from companies to replace dining room double doors, and Physician's Report. LPA and administrator toured the kitchen, dining room, double doors, food storage, back patio, rooms 6, 19, 27, 35, 37, 42, plate of food served, activity room, med room, nurses’ station, and administrators office. LPA attempted to open the dining double doors when the were closed, LPA Soto had a really hard time trying to open the double doors.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20210506100850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE
FACILITY NUMBER: 197607718
VISIT DATE: 07/16/2021
NARRATIVE
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Based on the LPA's investigation, the investigation revealed the following.

Allegation #1- Staff do not provide residents healthy food. On 05/17/21, Interviews conducted with Administrator and S#1 – S#5, stated that they facility provides healthy food. They serve fresh vegetables, fresh fruits, chicken, fish, and red meat. If the residents do not want or like what the facility is serving the have the option of asking for whatever they want to eat. All they do is fill out a meal substitute request form and they facility will try to provide them what they requested. Interviews with R#1 –R#6, stated the food is okay. They serve decent food. They all eat the food in the facility they have good portions also. They can ask for other foods, if they don’t like what they are serving for that day. LPA Soto observed the plate of food the facility served during lunch. It had protein, vegetables, and mashed potatoes. It was a well-balanced meal. The interviews, records, and LPA’s visual observation did not concur with the above 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 unsubstantiated

An exit interview was conducted with Elizabeth Hernandez, Social Worker and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 11-AS-20210506100850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE
FACILITY NUMBER: 197607718
VISIT DATE: 07/16/2021
NARRATIVE
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Based on the LPA's investigation, the investigation revealed the following.

For Allegation #1 – Facility door is too heavy for residents to open. Interviews conducted with Administrator, S#1 -S#5, R#1 – R#6, stated that the double doors are too heavy to open when the doors are closed. When they are closed, they use the sides doors to into the building. Administrator stated that the facility was looking into replacing the doors with automatic doors. LPA Soto physical inspection of double doors determined that the double doors are too heavy to open and especially for residents that utilize wheelchairs. The interviews and physical inspection concur with the above allegation.
Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

An interview was conducted with Elizabeth Hernandez` , Social worker, and a hard copy was provided along with Appeal rights.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20210506100850
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE
FACILITY NUMBER: 197607718
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2021
Section Cited
CCR
87303(a)
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87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This was not met as evidence by:Based on dining diouble doors are hard to open
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Administrator will repair double door and send repair invoice to LPA Soto by email, fax, or mail. POC due date 08/10/2021.
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which is poses a health and safety risk for the residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5