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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 09/17/2021
Date Signed: 09/19/2021 12:57:40 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: 55DATE:
09/17/2021
UNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Gwendoly Craig & Elizabeth HernandezTIME COMPLETED:
03:01 PM
ALLEGATION(S):
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Staff did not provide adequate assistance to meet necessary medical needs of the resident.
INVESTIGATION FINDINGS:
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On 09/17/21, Licensing Pogram Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit at this facility. LPA met with the Administrator Gwendolyn Craig and the Director of Social Services Elizabeth Hernandez and explained the purpose of today's visit was to collect information and deliver findings.

The investigation consisted of the following: Interview with Gwendolyn Craig, staff #3 (S3) witness #1 (W1), (R1)'s service records and other pertinent records in association with this allegation. A tour of the facilty was conducted.

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: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 7
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: 09/17/2021
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not provide adequate assistance to meet necessary medical needs of the resident.
The details on this allegation state the facility did not allow for (R1) to have access to transportation for medical appointments. (R1) reports the staff is not allowing him access to transportation vehicles. On 07/13/21, the staff refused transportation assistance for his medical appointment.

An interview with the administrator revealed (R1’s) in-house transportation was terminated on 07/12/21. The reason was due to personal conflicts between (R1) and (S3). The administrator took immediate action to de-escalate strife between the resident and staff by terminating (R1)’s in-house transportation services.

A decision the administrator felt was necessary as it created an unstable environment for both parties involved and other residents transported to their daily appointments. An interview with (S3) revealed that (R1) was dissatisfied with his services and it created an uneasy work setting between the resident and staff. The administrator stated the (R1) had alternative transportation assistance with Access Services. However, (R1) claims the services are not reliable. According to the administrator, in-house transportation services resumed for (R1) on 08/13/21 after an alternative plan was put in place.

Based on interviews and records reviews, there is sufficient evidence to support the allegation mentioned above had violated Title 22 regulations.

Based on interviews that were conducted record reviews, 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), and Chapter (8) are being cited on the attached LIC 9099-D.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
CCR
87465(2)
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87465 Incidental Medical and Dental Care (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation... medical or dental facility which will meet the resident's need. In providing transportation the licensee shall...make arrangements for this service.
This requirement was not met as evidenced by:
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The licensee will create a plan to ensure that the administrator performs knowledge of and conforms to applicable laws, rules and regulations with 87465 Incidental Medical and Dental Care Regulations. Plan of correction will be submitted by POC due date: 09/24/21.
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Based on interview and record review the licensee/Administrator failed to adhere to Title 22 regulations and terminated transportation services for (R1) and failed to meet resident’s needs. The violation poses a potential a potential health and safety risk to residents in care.
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This violation was corrected during the visit on 09/17/21. The licensee issued for in-house transportation services to resume with (R1) and implemented an alternative plan to meet (R1)'s needs.
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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: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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: 55DATE:
09/17/2021
UNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Gwendolyn Craig & Elizabeth Henandez TIME COMPLETED:
03:01 PM
ALLEGATION(S):
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Facility staff transports residents in an unsafe manner.
Resident does not receive medication delivery in a timely manner.
Facility has insufficient staffing to meet the resident’s needs.
INVESTIGATION FINDINGS:
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On 09/17/21, Licensing Pogram Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit at this facility. LPA met with the Administrator Gwendoly Craig and the Director of Social Services Elizabeth Hernandez and explained the purpose of today's visit was to gather information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: Interview with Gwendolyn Craig, staff #1-10 (S1-S10), residents #1-11 (R1-R11) and witness #1 (W1). A review of (R1)'s service records and other pertinent records in association with these allegations. A tour of the facilty was conducted.

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

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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: 09/17/2021
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff transports residents in an unsafe manner.

It is alleged that staff #3 (S3) is unsettling, throws tantrums, and drives dangerously. The Department conducted interviews with residents #2-#10 (R2-R10, staff #1-#10 (S1-S10) and witness #1 (W1) a review of (S3)’s personnel file and found there no evidence to support the allegation mentioned above.

An interview with (S3) states his primary duties are to transport residents to medical/dental appointments and that secondary duties are operational tasks for management. (S3) reports that he has been an employee for two and half years and claims that he had no complaints about his services nor how his driving performance. (S3) claims that he has a clear record with no driving violations. (S3) reports he has completed In-Service Ethics, Sensitivity, First Aid, CPR and Defensive and Safety Training.

Interviews with (R2-R10) revealed they all have utilized the transportation services provided in-house and felt safe during their transport services. (R2-R10) all claim that (S3) conducts himself professionally, communicates well and is committed to safety on the road. Interviews with (S1-S10) and (W1) all claim that accusation is manufactured and that (S3) is an excellent worker and well experienced and trained. Based on the information gather, there’s no evidence to collaborate the allegation mentioned above.

Resident does not receive medication delivery in a timely manner.

The detail of the allegation indicates the (R1) does not receive his medication delivery in a timely manner. Interviews conducted with staff #1-#2 (S1-S2) indicated (R1) is self responsible for his medications and does not need assistance with medication administration and that medications are sent to the facility by mail. (S1-S2) all stated that the mail is delivered to the resident the same day it arrives. The mail is delivered by USPS mail and is distributed by the administrator, med tech, or caregivers. The resident also comes to the front office to retrieve their mail. The administrator also stated that mail is received by the receptionist at the skilled nursing annex.

Evaluation Report continues on LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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: 09/17/2021
NARRATIVE
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The administrator then handles will separate it and gives the Assisted Living residents their mail daily. The administrator states, the mail delivery time may vary depending on the holiday that will affect the distribution process. The administrator claims the facility has no control over the USPS or any other mail services with the delivery schedules. A review of (R1)’s service records, confirms that (R1) is self-responsible for medications and refills. Interviews conducted with (R2-R10) reported they have no concerns with their mail and that it is being delivered timely. All the residents interviewed, there have been on knowledge with late mail delivery and stated they all had no difficulties receiving their medications timely. Based on the information gather, there’s no evidence to support the allegation mentioned above.

Facility has insufficient staffing to meet the resident’s needs.

The details of the allegation state there is insufficient staffing to meet resident #1 (R1)’s needs.
Staff is not providing appropriate care and supervision to the residents while in care. On 7/14/2021 the Department interviewed residents #2-10 (R2-R10) regarding care and supervision. All the residents indicated that their needs are being met. When one calls for assistance, the staff provides them with what is needed. Information provided by residents states there is always staff around to provide you with care to assist with assisted daily living activities. During the interview with the administrator, she indicated that there is always staff on shift to provide care and supervision. The administrator states staffing availability for the following shifts: eleven (11) morning shift; seven (7) swing shift; five (5) graveyard shift the numbers do not include kitchen staff. The administrator claims that during any staffing crisis; the staff is crossed trained to assist immediately with any job function. The administrator provided proof to verify staff is cross-trained. Interviews were conducted with (S1-S10) all confirmed that there is sufficient staffing in each shift to accommodate residents with required needs and they are crossed trained if needed for any staffing crises. An interview with witness #1 (W1) indicated there has been no hint to (R1) not being care for or supervised timely and states the staff is doing the best they under circumstances have to assist with a variety of needs. A review of (R1)’s service records indicated the resident is very much independent and requires minimal assistance with care or supervision. Based on the information collected, there’s no evidence to collaborate the allegation mentioned above.

Evaluation Report continues on LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 7
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: 09/17/2021
NARRATIVE
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The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, and interviews conducted and found no evidence to support the allegations: "Facility staff transports residents in an unsafe manner", "Resident does not receive medication delivery in a timely manner", "Facility has insufficient staffing to meet the resident’s needs".

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 Elizabeth Hernandez and a copy of the report was provided by email.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7