197607718-5-16-2023-11-AS-MVAO-CXKUMK-20231114144228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 05/16/2023
Date Signed: 05/16/2023 04:00:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
05/15/2023 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20230515114039

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: 60	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Gwendolyn Craig		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not ensuring that resident is administered their medication as prescribed.

INVESTIGATION FINDINGS:

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On 5/16/2023 Licensing Program Analyst (LPA) Felisa Shirley and Licensing Program Manager (LPM) Stephanie Cifuentes conducted an initial unannounced complaint visit at this facility. LPA Shirley and LPM Cifuentes arrived at the facility and spoke to Social Services Director Elizabeth Hernandez to explain the purpose of the visit it to investigate the allegation listed above. LPA and LPM were granted access to the facility. Administrator Gwendolyn Craig arrived later to join the visit.

The investigation consisted of the following:
On 5/16/2023 LPA Shirley and LPM Cifuentes met with Social Services Director Elizabeth Hernandez. LPA and LPM interviewed Resident 1- Resident 5 (R1-R5) and attempted to interview Staff 1-Staff 5(S1-S5). LPA and LPM reviewed and requested copies of the following records: client Roster, staff roster and staff schedule, physicians’ assessments, medication administration records, physicians orders for residents 1-5.

Con'd on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230515114039

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 05/16/2023

NARRATIVE

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The investigation revealed the following:
Allegation: Staff are not ensuring that resident is administered their medication as prescribed.
It is alleged that facility residents are not being given their medications by facility staff. On 5/16/2023 from 10:00am-11:50am LPA Shirley and LPM Cifuentes reviewed 5 resident records and 5 electronic medication administration records. A review of facility records shows that medications were given to facility residents in the correct dosage and at the correct times. Very few clients showed that they did not receive medications and upon further review it was noted that those whose records did have dates when a medication was not administered had corresponding notes showing medications were refused by clients, or depending on the record reviewed, some were not prescribed until later dates.

On 5/16/2023 from 11:50am-2:00pm LPA Shirley and LPM Cifuentes interviewed Resident 1-Resident 5 (R1-R5). Of those residents interviewed, 4 out of 5 residents stated facility staff had not missed dispensing their medications. On 5/16/2023 from 11:50am-2:00pm LPA Shirley and LPM Cifuentes interviewed Staff 1-Staff 5(S1-S5). Out of those interviewed, 5 out of 5 staff stated residents had not missed any medications. During the course of the interviews, it was noted that some residents have refused medications and have later asked staff to administer medications, but due to the medication guidelines, medication could no longer be administered.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted. A printed copy of this report was left with the Administrator Gwendolyn Craig, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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