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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802527
Report Date: 07/21/2025
Date Signed: 07/21/2025 07:20:07 PM

Substantiated


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
07/15/2025 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250715152317
FACILITY NAME:SCANDIA GUEST LODGEFACILITY NUMBER:
197802527
ADMINISTRATOR:ERICKA JIMENEZFACILITY TYPE:
735
ADDRESS:1248 E. 10TH STREETTELEPHONE:
(562) 599-2451
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:74CENSUS: 63DATE:
07/21/2025
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Ericka JimenezTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Staff do not treat residents with dignity or respect.
INVESTIGATION FINDINGS:
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On July 21, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial visit to gather information regarding the above allegation. LPA met with Ericka Jimenez and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of an initial visit, a collection of records, and a tour of the facility. Interviews were conducted with the Administrator staff members #2 to #3 (S2-S3), clieints #1 to #6 (C1-C6). Staff #1 was not available for an interview. List of documents reviewed/obtained Registered of Facility Clients LIC 9020 (dated 02/192025), Personnel Report LIC 500 (dated 07/09/25), Staff Training (dated January through Decemer 2025) and other records pertinent to this complaint.

(Evaluation Report continues LIC 9099-C)

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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 4
Control Number 11-AS-20250715152317
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: SCANDIA GUEST LODGE
FACILITY NUMBER: 197802527
VISIT DATE: 07/21/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff do not treat clients with dignity or respect.

It is alleged that facility staff do not treat clients with dignity or respect. It is reported that Facility Staff #1 (S1) would make Clients #1 and Client #2 stand outside the building to hand them their medications. (S1) expressed a genuine dislike for lack of hygiene care, and actions intentionally came across as shameful and are perceived as hurtful. It reported that management is aware of these behaviors, yet no action has been taken to address them. No further details were provided in this matter.

On July 21, 2025, between 09:50 AM and 11:35 AM, the Department interviewed the staff member identified as Administrator (AD #1). (AD1) verified that the individuals identified as Client #1 (C1) and Client #2 (C2) had received special treatment and that their medication was administered by Staff #1 (S1). It was brought to management's attention that (S1) was administering medications to (C1 and C2); (S1) instructed to have (C1 and C2) remain outside the building to collect their medications during the afternoon and evening shifts. This decision stemmed from concerns regarding personal hygiene and was reported to be offensive to (S1). Once it was brought to management's attention, (S1) was removed from the position as a medical technician and is no longer administering medications to clients in care.

Additional interviews with Staff #2 and Staff #3 (S2-S3) provided insights regarding the situation. Both staff members affirmed that all individuals are treated with respect and highlighted their commitment to ensuring that no clients are left outside the building during medication administration.

On July 21, 2025, between 10:10 AM and 11:35 AM, the Department interviewed client members identified as Client #1 through Client #6. Two (2) out of the six (6) client members were able to corroborate this claim. (C1 and C2) verified that they were restricted from receiving their medications inside the building by (S1). (C1 and C2) specifically mentioned that only (S1) would advise them to remain outside when handing their afternoon and PM meds. They were kept in the dark, never receiving an explanation or the motives behind such unequal treatment.

In interviews with (C3 to C6), all individuals consistently reported that they did not receive any specialized treatment. They expressed appreciation for the staff's behavior and consistently demonstrated a level of respect, upholding their dignity during interactions.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250715152317
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: SCANDIA GUEST LODGE
FACILITY NUMBER: 197802527
VISIT DATE: 07/21/2025
NARRATIVE
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Staff member #1 (S1) was unavailable for an interview, despite several attempts to contact (S1) by telephone.

During the visit, the Department inspected the Medication Room and observed the storage, preparation, administration, and documentation of medications in compliance with Title 22 Regulations. The Department found that the medications are maintained in an orderly and accurate manner. A review of Medication Administration Records is complete and correct. Further reviews of staff training have been completed, including Effective Communication, General Workplace Safety, Assisting with ADLs, Administration of Medications, Documentation, and First Aid. A review of Personnel Report LIC 500 (dated 07/09/2025) revealed that Staff #1 (S1) is no longer serving in the role of Med-Tech. Additional review of Physicians Report LIC 602 for Client #1 and Client #2 (dated 01/17/23 and 03/13/25) revealed that both clients have the capacity for self care with hygiene needs.

Based on evidence gathered, interviews conducted, records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of PERSONAL RIGHTS: “Staff do not treat residents with dignity or respect.” is found to be found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 1), the following deficiency has been observed and a citation issued (ref. LIC 9099D).

An exit interview has been conducted, and a copy of the Complaint Report and Appeal Rights was provided to the Administrator Ericka Jimenez.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250715152317
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: SCANDIA GUEST LODGE
FACILITY NUMBER: 197802527
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2025
Section Cited
CCR
80072(a)(1)(2)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to...(1) To be accorded dignity in his/her personal relationships with staff and other persons. (2)To be accorded safe, healthful and comfortable accommodations... to meet his/her needs.
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Licensee/Administrator shall ensure that training for all staff on Title 22, Section 80072 “Personal Rights” is conducted and send the sign-in sheets and training materials to the CCLD by the Plan of Correction (08/04/25) due date, Attn: Ernand.Dabuet@dss.ca.gov.
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This requirement is not met as evidenced by: Staff #1 violating Client #1 & #2's personal rights during medication administration and giving unequal treatment when instructed to remain out of the building.This violation poses a potential health and safety risk to persons in care.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4