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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 10/26/2021
Date Signed: 03/28/2022 12:19:48 PM

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
10/20/2021 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20211020132720
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: 53DATE:
10/26/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Gwen CraigTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Facility does not provide adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, October 26, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Gwen Craig. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the investigation, LPA Bunker interviewed staff 1-4 (S1-S4), and residents 1-7 (R1-R7), LPA Bunker asked questions relevant to the nature of the complaint. Staff and residents stated the facility has a new Nutrition & Dietetics Food Service Manager. Staff stated the residents have complained about the food portions. S1-S4 and residents R1-R7 stated the issues with the food were corrected and no longer a problem. Staff stated the incident was self-reported to Community Care Licensing promptly.

See continued LIC9099-C page #2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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 3
Control Number 11-AS-20211020132720
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: 10/26/2021
NARRATIVE
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Continued LIC9099-C page #2

Allegation: The facility does not provide adequate food service. Staff and residents stated residents were not provided adequate food. The problem was corrected. LPA Bunker observed the facility's food. The facility has an ample supply of perishable and non-perishable food. The administrator reported a special incident report regarding food service prior to the complaint.

Investigation revealed the following: Interviews were conducted with staff 1-4 (S1-S4) and residents 1-7 (R1-R7). During the interviews, S1, S2, S3, stated the facility has a new nutritionist & dietician food service manager she was serving the resident a small portion of food based on the facility menu for Centinela Skilled Nursing Facility next door shares the same kitchen and cooks. The nutritionist & dietician food service manager was not aware assisted living had a separate menu from the skilled nursing facility. She has corrected the problem and residents are receiving the required amount of food and beverages. R1, R2, R3 stated they were not receiving enough food. R4, R5, R6, R7 stated they are receiving enough food. R1 is the only resident that stated he is not receiving evening snacks and go to bed hungry. All seven residents stated the food service problem is now resolved. S1-S4 and R1-R7 stated residents are now receiving the quantity of food to meet residents' needs.

Based on LPA’s observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D.

Appeal rights were discussed, and copies of LIC9099, LIC9099-C, LIC9099-D, and LIC811 were provided to the Administrator Gwen Craig

Exit interview conducted.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20211020132720
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: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2021
Section Cited
CCR
87555(a)
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87555 (a) Food Services:
The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council.
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The deficiency was corrected prior to today's visit.
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All food shall be selected, stored, prepared, and served in a safe and healthful manner.

The facility did not provide adequate food service.

The violation poses a potential health and safety risk to residents in care.
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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: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3