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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 07/21/2021
Date Signed: 07/21/2021 07:15:37 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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2021 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210709155908
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:
07/21/2021
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:GWENDOLYN CRAIGTIME COMPLETED:
03:31 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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On 07/21/21, Licensing Pogram Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit at this facility. LPA met with Gwendolyn Craig, Administrator and explained the purpose of today's visit was to collect information and conduct staff interviews regarding the allegation mentioned above.

The investigation consisted of the following: Interview with Gwendolyn Craig, Administrator and Elizabeth Hernandez, Social Service Director. A tour of the plant facilty on 07/14/21 and 07/21/21.

Investigation Revealed the following:
The complainant reported the front entry door is not working properly which causes delays for deliveries. The Department interviewed (R-1) and was informed that the facility is in disrepair with the front door is not working correctly.

Evaluation Report Continue on LIC-9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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 4
Control Number 11-AS-20210709155908
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: 07/21/2021
NARRATIVE
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Interviews conducted with the Administrator (S-1) and Social Services (S-2) both reported the entry door is not working properly and it has not been maintained in working condition for approximately six months.

The Department conducted a tour of the facility and observed the entry door on 07/14/21 and 07/21/21 unable to fully close. The entry door is a commercial grade double glass door. The left door does not close automatically and leaves a slight six inches half-open and must be shut manually. A door that has been left unshut and unattended is a security and safety issue.

During the interview with the administrator confirmed she is aware of the concern and a replacement door or repair is scheduled to fix the problem.

Based on LPA’s observation and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation of “Facility is in disrepair" is found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

An exit interview was conducted with Gwendolyn Craig. The Rights were discussed, and a copy of Appeals Procedures for Licensees was provided, as well as a copy of this report to the Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20210709155908
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2021
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation. The facility shall be clean, safe, sanitary, and in good repair at all times. Maintenance shall include the provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors.

This requirement is not met as evidenced by:
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The administrator will ensure that the item listed under this deficiency have been corrected to ensure compliance with California Code of Regulations Title 22, Section 87303 and provide proof of correction to CCL by the POC due date: 08/04/21.
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LPA observed on 07/14/21 & 07/21/21 the front entry door did not operate properly. The left side of the double door did not shut completely and must shut manually. This is a violation that poses a potential Health and Safety or Personal Rights risk in 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: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4