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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 08/16/2021
Date Signed: 08/18/2021 09:36:39 AM

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
07/27/2021 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210727102124
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: 49DATE:
08/16/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Gwendolyn Craig, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Staff forgets to provide resident with medication for outings
Resident's hygienic care needs are not being met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to conduct further investigation and deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Gwendolyn Craig, the facility administrator.

The investigation consisted of following: Interviews and Record reviews. On 07/30/21, LPA Soto interviewed medical assistant Laura Lopez. On 08/16/21, LPA Soto interviewed Administrator Gwendolyn, S#3, R#1 – R#5. Toured rooms #2, #41, #23, and #16 and dining room, patio, and administrator office, and medication room. LPA Soto received the following documents on 08/16/21: Resident Roster, Staff Schedule, VA Medical report, needs and services plan, admissions agreement, and medication logs for R#1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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 2
Control Number 11-AS-20210727102124
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: 08/16/2021
NARRATIVE
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Based on the LPA's investigation, the investigation revealed the following. For Allegation #1 - Staff forgets to provide resident with medication for outings. Interviews with administrator, S#1, & S#3, stated that they always give the residents their medication. R#1 needed their medication, but the Medicine Technician was out to lunch and R#1’s family member refused to wait 10 – 15mins to wait for the Medicine Technician to come back from lunch and still took R#1 for their outing anyway. They left without R#1 medicine. R#3, R#4, R#5 all sated that they get their medicine every day on time, never missed a dose. The interviews do not concur with the above allegation.

Allegation #2 - Resident's hygienic care needs are not being met. Interviews with administrator, S#1, & S#3, they all stated that the residents that choose to bathe are always helped, there are those residents that are difficult and refuse to bathe. The staff cannot force them to look after their hygiene or make them do anything they do not want to do. R#1 becomes aggressive and refuses to deal with his own hygiene, even when administrator and staff try to encourage him to do so. Interviews with R#1, R#2, R#4, & R#5, stated they do not have any problems with meeting their own hygiene needs. R#3 requires help with their hygiene needs, the staff always helps R#3 with their hygiene needs. LPA Soto reviewed records and it revealed that R#1 does have mental condition that can make R#1 aggressive. The interviews and records reviewed do not concur with the above 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 with Gwendolyn Craig, Administrator, and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2