197607718-5-27-2022-11-AS-AJKK-CETVRF-20220527163951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 04/18/2022
Date Signed: 05/27/2022 12:16:43 PM

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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2021 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211029152115

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:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Cinthia Burgos		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not properly assist residents with their medication management
Staff yelled at a resident in care
The facility is in disrepair
Resident was inappropriately touched while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, April 18, 2022. Upon arrival at the facility. LPA Bunker called the facility via telephone spoke to Administrator Gwen Craig and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Med Tech Cinthia Burgos LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation LPA Bunker interviewed staff 1-5 (S1-S5) and residents 1-6 (R1-R6), LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker requested copies of R1's records, Medications, Admission Agreements, Consent for Emergency Medical Treatment, Identification and Emergency Information, Personal Rights, House Rules, Resident Roster, and Personnel Report. Med Tech Cinthia and LPA Bunker observed the resident's medication and reviewed records. LPA Bunker observed Cinthia dispensing medication to residents according to their physician's directions. We toured and observed room #22 patio door. the patio sliding door was operable at the time of today's visit. See continued LIC9099 page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

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-20211029152115

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: 04/18/2022

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: The staff does not properly assist the resident with their medication management:
Staff 1-5 (S1-S5) and resident 2-6 (R2-R6) stated staff does properly assist residents with their medication. Staff stated that R1 was admitted to the above facility on 08/25/2021. (R1) was a former resident of Maywood Healthcare & Wellness a skilled nursing home. Staff stated they are administering R1's medications according to her doctor's orders. The facility has four (4) trained Med Techs that assist residents with medication. The Administrator stated their Med Techs are trained and dispensed medications according to the resident's physician's order, some of the residents have instructions from their doctors and they safely handle their own medications. S1-S5 and R2-R6 stated the allegation is false.

Allegation #2 Staff yelled at a resident in care:
Staff 1-5 (S1-5) and residents 2-6 (R2-6) stated staff does not yell at residents in care. Residents are treated with dignity and respect. S1-S5 and R2-R6 stated the allegation is false.

Allegation #3 Facility is in disrepair:
Staff 1-5 (S1-S5) stated that R1's patio door is working properly and is maintained in working condition. R1 will knock the sliding screen off the rail and staff is constantly putting the screen back on the rail. We toured R1's room #22 and observed the sliding patio door working on 11/08/2021 and 04/18/2022 the patio door is operable and in working condition.

Allegation #4 Resident was inappropriately touched while in care:
Staff 1-5 (S1-S5) and residents 2-6 (R2-R6) stated none of the residents in placement is inappropriately touched. S1-S5 and R2-R6 stated that they never witness any resident inappropriately touching another resident. S1-S2 stated R1 mentioned the incident to staff, but didn't want staff to do anything about it. R2 stated he never touched R1 on the legs inappropriately and R1 is a liar and is lying.

See continued LIC9099-C page 3

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211029152115

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: 04/18/2022

NARRATIVE

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Continued LIC9099-C page 3

Investigation revealed the following: LPA Bunker conducted interviews with staff 1-5 (S1-S5) and residents 2-6 (R2-R6) they all stated staff dispenses medications according to the resident's physician's directions. LPA observed R1 medications and found no evidence to support the allegations. S1-S5 and R2-R6 stated the staff does not yell at residents in care. R1 admitted that she yelled and curses at the facility staff. The facility is not in disrepair and is cleaned, disinfected, and sanitized twice a day and as often as needed. S1-S5 stated If something at the facility is broken the maintenance staff will repair it immediately. S1-S5 stated R1 keeps breaking the sliding patio screen door and maintenance repairs it. S1-S5 stated that R1 keeps knocking the screen door off the rail. On 11/08/2021 and 04/18/2022, we observed the sliding patio door and screen it was working in an operable condition during the visit. S1-S5 and R1-R6 stated they never witness any resident inappropriately touching R1. S1-S2 stated R1 mentioned the inappropriately touching incident to staff, but R1 did not want staff to do anything about it. During the interview, R2 stated he never touched R1 on the legs inappropriately and R1 is a liar and is lying. R2-R6 interviewed stated that they are all happy with how they are treated by the facility staff and they had no problems or complaints. R2-R6 stated if they need assistance with anything staff is always available to assist. R2-R6 stated staff provided them with the necessary care and supervision. S1-S5 and R2-R6 were interviewed and they all denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

LPA Bunker provided Administrator Gwen Craig with copies of the Complaint Investigation Report LIC9099, LIC9099-C, and LIC811.

An exit interview was conducted.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

LIC9099 (FAS) - (06/04)

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