197607718-11-23-2021-11-AS-EMAZ-C9WV6G-20211221150930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 11/19/2021
Date Signed: 11/23/2021 11:56:35 AM

Unsubstantiated

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211116143349

FACILITY NAME:	CENTINELA ASSISTED LIVING CENTRE		FACILITY NUMBER:	197607718
ADMINISTRATOR:	GWENDOLYN CRAIG		FACILITY TYPE:	740
ADDRESS:	1000 S FLOWER ST		TELEPHONE:	(310) 674-3216
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90301
CAPACITY:	96	CENSUS: 56	DATE:	11/19/2021
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	ELIZABETH HERNANDEZ		TIME COMPLETED:	03:29 PM

ALLEGATION(S):

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Resident is not receiving prescribed diabetic medicine at the facility.

INVESTIGATION FINDINGS:

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On 11/19/21 , Licensing Program Analysts (LPAs) Ernand Dabuet conducted an unannounced complaint visit at this facility, LPA was greeted by assistant administrator Elizabeth Hernandez LPA explained the purpose of today's visit was to gather information on the allegation above. The administrator Gwendolyn Craig was made aware of the visit and was able to join the visit.

The investigation consisted of the following: An interview was conducted three (3) staff, and (6) residents. A review of the current staff and resident roster and resident #1 (R1's) service records and other pertinent records was reviewed. A tour of the physical plant was conducted during the visit.

Evaluation Report continues LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

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-20211116143349

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/19/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident is not receiving prescribed diabetic medicine at the facility.

The detail on the allegation states resident #1 (R1) is not given her insulin shots. The complainant reports that administrator Gwendolyn Craig and a caregiver informed (R1) on 11/12/21 that they can no longer provide the resident with her insulin shots. (R1) was informed that she has to administer the shots on her own. The complainant states the medical orders were from (R1's) physician. The Department interviewed (R1) and was informed that she refuses to do her insulin as she did find comfort in doing it herself. According to (R1) she is capable of doing so but refuses as she bruises herself and that staff would assist her injecting Lantus insulin twice daily. According to (R1) she has not seen her primary care physician in two (2) years and that is no new orders are in place stating that she had to do the insulin injections herself. (R1) claims that the facility refuses to show her any doctor's orders in writing. (R1) states she is not being assisted by any home health agency and does not require to be on one.

According to (R1's) service records, (R1) was admitted on 08/25/21 at this facility. (R1) was a former resident of Maywood Healthcare & Wellness a skilled nursing home. At the nursing home (R1) was accustomed to being assisted by nurses with her daily insulin injections. According to (R1's) Physician's Report (LIC 602A) dated 8/24/21, (R1's) can administer her injections. Physical evidence indicates on (R1's) Admission Orders can manage her medications including Metformin and Lantus to manage her health condition. Reports from (R1's) primary care physician revealed visits were conducted to conduct medical evaluations on 09/10/21,10/08/21 and 11/04/21 in which disputes (R1's) claim that she has not been seen by her primary care doctor in two years. According to (R1's) progress notes, (R1) had done Latus Insulin self-injections in the early part of September 2021 and will substitute Metformin to monitor her blood sugar levels. Interviews with the administrator (S1) and staff #2 (S2) both dispute (R1's) claim that she was being assisted with her insulin injections. (S1-S3) claim that they do not give injections as the action would b in violation of Title 22 regulations. However, they will ensure that a sufficient amount of mediation, testing equipment, syringes, needles, and other supplies are maintained. They provide a hand-over-hand service to (R1). (S1-S3) all claim they continue to monitor (R1's) blood level daily.

Evaluation Report continues on LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211116143349

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/19/2021

NARRATIVE

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An interview with (R1's) primary care physician's witness #1 (W1) states that they will work with (R1) to reassess her medical condition to have home health come and assist with the insulin injections weekly. (W1) disputes (R1's) claim that she had been neglected in care by her primary care physician. (W1) states we have records of all the visits conducted with (R1). (W1) reports that (R1) is reluctant to follow the physician's orders and will not hold the facility in any way responsible for (R1)'s refusal for medical care. The Department review (R1's) Medication Administration Records and found them accurate and to be maintained in order. Interviews were conducted with residents #2-#4 (R2-R4) all conducted their insulin injections and states they have no issues with the staff. The staff does not assist with the actual injections of insulin. Interview with residents #5-#6 (R5-R6) both claims the staff is very responsive and in assisting with their medications and have never been denied of their medications. Based on the Department’s observation, interviews, and a review of service records that were conducted, the Department found there is no evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, review of (R1’s) service records, and other pertinent documents relevant to this case, interviews conducted and found no evidence to corroborate the allegations mentioned above.

Based on the information gathered, there is no evidence to support the allegations: "Resident is not receiving prescribed diabetic medicine at the facility".

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 Gwendolyn Craig and a copy of the report was provided by email.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021

LIC9099 (FAS) - (06/04)

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