197609367-7-23-2024-11-AS-JHAD-D8JQ2M-20240827114718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609367
Report Date: 07/23/2024
Date Signed: 07/23/2024 11:28:27 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2022 and conducted by Evaluator Sparkle Day

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221216140503

FACILITY NAME:	SANTA MONICA HOME & CARE 4		FACILITY NUMBER:	197609367
ADMINISTRATOR:	GARY STRATHEARN		FACILITY TYPE:	740
ADDRESS:	910 10TH ST UNIT A		TELEPHONE:	(310) 576-0044
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	4	CENSUS: 3	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Jennifer Block		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff do not ensure that COVID safety practices are being followed
Staff did not ensure resident has personal privacy in accommodations
Staff allowed resident to sleep in a common room

INVESTIGATION FINDINGS:

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This report supersedes the report dated 12/20/2022, the purpose of this amendment is to provide clarification on the circumstance surrounding the allegations. although this report supersedes the previous report the complaint investigation findings remain the same: Unsubstantiated

On 12/20/22 LPA Alvizar obtained the following documents Personnel Report, Resident Roster, Residents #1-2’s Admissions Agreements, Physician Report, ID and Emergency Information, and Unusual Incident Report for R#1. LPA conducted Interviews with administrators, residents #1- #2 (R1-R2), Staff #1- #6 (S1-S6) and witness #1-#2 (W1 – W2). LPA Alvizar and Administrator Jennifer toured the facility physical plant.

During todays visit 7/23/2024 LPA Sparkle Day conducted an subsequent visit to do interviews. At approximately 10:00 am LPA Day interviewed Staff #1 - Staff # 4 and Resident #1. Due to R2s medical diagnoses they are unable to provide an answer.LPA toured the facility at approximately 10:40am.

Regarding the allegation : Staff do not ensure that COVID safety practices are being followed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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-20221216140503

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA MONICA HOME & CARE 4	FACILITY NUMBER: 197609367
	VISIT DATE: 07/23/2024

NARRATIVE

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During interviews conducted, 1 out of 2 residents disagreed with the allegation, R#1 states the facility follows Covid safety practices always. Due to R#2’s medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation. Staff state, We follow our Covid plan we clean and wear full gear, mask, gown, gloves when there is a positive COVID in the facility. We sanitize everything, take temperature and wash hands continuously. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding the allegation: Staff did not ensure resident has personal privacy in accommodations
During interviews conducted, 1 out of 2 residents disagreed with the allegation, resident R1 states they all have their own rooms if we wany privacy , but we come out when we want to mingle with the other residents and staff. Due to R #2’s medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation. Staff state we always provide residents with privacy if and when they choose. Everyone has their own room, they can stay in their rooms whenever they want
Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff allowed resident to sleep in a common room
During interviews conducted, 1 out of 2 residents disagreed with the allegation, R#1 states they all have their own rooms and no one sleeps in the common rooms. Due to R2 medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation and state all residents have their rooms and only if they are in the common rooms and take a short nap while watching television is the only time they are sleep in a common area. Residents go to bed at night in their bedrooms only.
Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A copy of the Complaint Investigation Report was provided to Administrator, Jennifer Block. An exit interview was conducted.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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