197803745-12-6-2024-28-AS-DSIS-DBX326-20241213165121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 12/06/2024
Date Signed: 12/06/2024 02:26:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/04/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241204125128

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: 74	DATE:	12/06/2024
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Ana Giron - Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff does not accord resident privacy.
Staff does not accord resident respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Administrator Ana Giron and explained the purpose of today's visit.

The investigation consisted of the following:

LPA obtained copies of staff & resident rosters and conducted interviews with 5 Staff and 7 Residents.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

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 28-AS-20241204125128

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTRY INN OF DOWNEY	FACILITY NUMBER: 197803745
	VISIT DATE: 12/06/2024

NARRATIVE

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The investigation revealed the following:
Allegation: Staff does not accord resident privacy.
It is alleged that staff are spying on residents and access the roof when spying. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation. Staff stated that they always announce themselves before entering a room and have never observed any suspicious spying activities from staff or residents. Staff stated they do not access the roof for unnecessary reasons, and access to roof does not happen often. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation and stated that they do not feel that their privacy is being invaded by staff. Residents confirmed that staff always announce themselves before entering their rooms and will not enter if they are asked not to.

Allegation: Staff does not accord resident respect.
It is alleged that staff (S1&S2) harass R1 by making unnecessary noise at night in efforts to be disrespectful towards resident. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation. S1 confirmed there aren’t any renovations going on where there will be excessive noise and that they have never intentionally made noise to upset residents, S5 confirmed that they do not make unnecessary noise to upset residents nor do they spy or have seen other staff spy on residents. All staff confirmed that if a resident resides on the first floor there may be noise heard as there is a second floor and some residents have trouble sleeping, causing noises of the elevator, going up and down stairs or moving about in their rooms. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation. Residents stated that sometimes they can hear noise and its believed that the noise is coming from residents that reside on the 2nd floor dragging their walkers through the halls or in their bedrooms, but the noise isn’t excessive and have no complaints.

Based on statements and interviews conducted with Staff and Residents, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview held, and a copy of this report was provided to Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024

LIC9099 (FAS) - (06/04)

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