197803745-8-17-2023-28-AS-RORN-CWHU5Q-20231011151708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 08/17/2023
Date Signed: 08/17/2023 04:53:01 PM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230811163253

FACILITY NAME:	COUNTRY INN OF DOWNEY		FACILITY NUMBER:	197803745
ADMINISTRATOR:	ANA YESENIA GIRON		FACILITY TYPE:	740
ADDRESS:	11111 MYRTLE ST.		TELEPHONE:	(562) 869-2401
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	150	CENSUS: 61	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Ana Giron, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are not allowing residents to have visitors.
Facility water is in disrepair
Residents are not able to effectively communicate with staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above today. LPA met Administrator, Ana Giron and explained the purpose of today's complaint investigation visit.

During the investigation visit was conducted, LPA Tao obtained staff roster, resident roster, resident#1’s (R1) records, interviewed residents from resident#1 (R1) to resident#7 (R7), interviewed staff from staff#1 (S1) to staff #5 (S5), and conducted a facility tour.

The investigation revealed the following:
In regard of allegation, “staff are not allowing residents to have visitors,” it was alleged that resident#1(R1) was not allowed to have visitors for visit at the facility. LPA interviewed residents, R1 stated facility did not allow visitors to visit resident. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that residents were allowed to have residents for visit at the facility.
(-continued in LIC9099C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 28-AS-20230811163253

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTRY INN OF DOWNEY	FACILITY NUMBER: 197803745
	VISIT DATE: 08/17/2023

NARRATIVE

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Per staff interviews, all five (5) staff interviewed were denied the allegation. Staff interviews revealed residents had rights to have visitors. During today’s visit, LPA observed staff allowed visitors to visit residents. Thus, residents were allowed to have visitors for visits at the facility.

In regard of allegation, “facility water is in disrepair,” it was alleged that facility’s tap water was cloudy, no hot water in the morning and water switched back and forth from hot to cold. LPA interviewed residents, R1 stated the facility’s tap water was cloudy and water switched from hot to cold; however, R1 stated there was hot water in the morning. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that facility’s tap water was clear, always had hot water in the morning and the water temperature was stable. All staff interviewed denied the allegation. Staff interviews revealed water was good and clear. Staff measured and logged hot water temperatures three times daily; and hot water temperature was consistent throughout the day. LPA observed there were additional filtered water tank and ice machine available to residents to stay hydrated. Thus, facility water was not in disrepair.

In regard of allegation, “residents are not able to effectively communicate with staff,” it was alleged that resident#1(R1) was unable to communicate with maintenance staff when asking questions about the water issue. Per resident interviews, R1 stated resident had a hard time communicating with staff. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that residents were able to communicate with staff and staff were able to assist residents. Per staff interviews, all five (5) staff interviewed denied the allegation. Staff interviews revealed that facility’s maintenance job was outsourced and services were provided by an outside agency. Therefore, the maintenance staff was outside agency’s staff. Residents should address their needs to facility staff. Thus, facility staff were able to effectively communicate with staff.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted, findings were discussed and a copy of this report was provided to Administrator, Ana, at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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