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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:31:09 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
09/21/2022 and conducted by Evaluator Jeremiah Randle
COMPLAINT CONTROL NUMBER: 11-AS-20220921164228
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: 63DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Administrator Gwendolyn CraigTIME COMPLETED:
03:36 PM
ALLEGATION(S):
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Facility staff is withholding resident's cash resources
INVESTIGATION FINDINGS:
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On 9/26/2022 at 10:30 a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced visit to deliver the findings of the complaint with the above allegation. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Gwendolyn Craig. LPA conducted interviews with Administrator (S1) and reviewed documents from the facility such as admission agreement, discharge report, and resident's financial detail statement including any other pertinent documents such as undelivered closing check dated 9/14/2022 remaining in the file and not given to resident at discharge. Resident was discharged on 11/18/2021
Findings: Based on interviews and records reviewed, the preponderance of evidence standard has been met. LPA finds the alleged violation did occur; therefore, the allegation is SUBSTANTIATED.
The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. This poses a potential risk to Health and Safety or personal rights to clients/residents in care.

Exit interview held with Administrator Gwendolyn Craig. A copy of the report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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 2
Control Number 11-AS-20220921164228
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: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2022
Section Cited
CCR
87217(i)
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Upon discharge of a resident, all cash resources, personal property and valuables of that resident which have been entrusted to the licensee shall be surrendered to the resident...
This requirement is not met as evidenced by:
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Administrator to submit proof of payment back to authorized representative for Resident 1 by POC due date. 9/28/2022
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Based on interviews conducted and information gathered the licensee failed to return personal property (money) to resident which had been entrusted to the licensee not surrendered to the resident.
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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: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2