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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 10/26/2022
Date Signed: 10/26/2022 02:00:36 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
10/19/2022 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221019155514
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: 67DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Elizabeth Hernandez, Social Services DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff did not dispense medication as prescribed
INVESTIGATION FINDINGS:
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On 10/26/2022, Licensing Program Analyst (LPA) Troy Agard conducted an unannounced initial complaint visit at the facility above. LPA met with Elizabeth Hernandez, Social Services Director and explained the purposed of the visit is to gather information for the allegation listed above.

The investigation consisted of the following: On 10/26/2022, LPA conducted a tour of facility grounds, reviewed records and interviewed staff and residents. LPA Agard requested the following documents which were received at the time of visit: 1) staff roster, 2) resident roster, 3) medication administration for R1.


cont on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 3
Control Number 11-AS-20221019155514
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: 10/26/2022
NARRATIVE
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The investigation revealed the following: Regarding the allegation… Facility staff did not dispense medication as prescribed. It’s being alleged that a resident did not receive a psychotropic medication for several days. LPA interviewed 5 out of 67 residents. 4 out of 5 denied the allegation. R2-5 all unanimously agreed that they have not had any issues with medication being given as prescribed. R1 states, “I was at the assisted living and they didn’t have my meds for 15 days. I was hallucinating. When I asked them where my meds were, they told me that they were short staff and they didn’t have time to order them.”

During interviews with staff, LPA interviewed 4 out of 17 in total. 4 out of 4 could not confirm the allegation to be true. S1 states, “I wouldn’t know what really happened because I was out on leave during that time.” S2 states, “R1 may have missed the first two days of medication because we have to wait for the doctor to send the work orders.” S3 states, “There were no staff shortages while R1 was here. We went live with our new medical system Point Click Care (PCC) in April 2022. The staff are having some difficulties with the system and they are not clicking that they give the meds. They may have given it to R1, but they didn’t document it.” S4 denies ever giving meds to R1, “I’m not aware of R1 missing any medication. I don’t recall mentioning anything to them. I don’t recall giving R1 any meds.”

During record review, LPA reviewed a staff schedule for the current month that coincides with the staff interviewed. LPA reviewed a resident roster, dated 10/19/2022, that coincides with the residents interviewed. LPA Agard reviewed the medication record for June and July 2022 for R1. LPA observed medication was given by S2 and S4. LPA observed, on some days, all medications was missed for several days during both months. This includes the specific psychotropic medication prescribed for daily administration. LPA observed it was not given during the first 20 days per the medication record review.



Based on LPA’s observation, interviews conducted, and record review, 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 Chapter 8 is being cited (please see LIC9099D.)

An exit interview was conducted. Plans of correction were developed. A copy of this report and appeal rights were given.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20221019155514
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: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2022
Section Cited
CCR
87465(c)(2)
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87465 Incidental Medical and Dental Care C)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by: Based on a record review, LPA observed LPA observed, on some days, all...
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Administrator will re-train all staff on the facility’s medication systems. Including but not limited to medical system Point Click Care (PCC). Re-training of all medication technicians must be conducted by POC due date and copies of training with sign-in sheet must be sent to LPA via fax or email.
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medications was missed for several days during both months. This includes the specific psychotropic medication prescribed for daily administration. LPA observed it was not given during the first 20 days per the medication record review.
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
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