197803745-10-4-2022-28-AS-MVAO-CL2TSU-20221110135944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 10/04/2022
Date Signed: 10/04/2022 04:09:11 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
09/26/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220926082544

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: 65	DATE:	10/04/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Ana Giron		TIME COMPLETED:	04:23 PM

ALLEGATION(S):

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Facility not providing a comfortable temperature for residents in care.
Facility staff not responding in a timely manner.

INVESTIGATION FINDINGS:

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On 10/04/22 at 12:45 p.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Ana Giron (Administrator) and explained the purpose of the visit.

During today’s visit LPA and administrator toured the facility and tested the call button in rooms 3, 15, 22, 23, 25, 27 and 48. LPA obtained resident/ staff roster, service report from Heating and Air Inc. dated 9/23/22 and took a photo of facility thermostat. LPA also interviewed: Administrator and a total of two (2) staff who shall be referred to as S1, and S2. LPA interviewed a total of 7 current residents who shall be referred to as: R1 through R7.

Report continued 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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-20220926082544

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: 10/04/2022

NARRATIVE

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The investigation reveals the following: Regarding "Facility not providing a comfortable temperature for residents in care", it is alleged that the rooms are hot, with it being 88 degrees F. outside and 84 degrees F. inside. During the visit LPA toured the facility and observed the facility thermostat at 75 degrees F. LPA reviewed service report and confirmed the air conditioner was not broken, and it was the facilities bi-annual service work. Administrator and 2/2 staff interviews confirmed the air conditioner was never broken but was serviced on 9/23/22. The administrator and 2/2 also stated 10-12 rooms share the same air conditioner and if a resident is cold in one of those units, they would offer a blanket, close the vent or rearrange the room to position the resident away from the vent. 6/7 residents stated the facility is comfortable and they have no problems with the temperature. 1/7 residents stated their room was hot and the air conditioner was not blowing out air. LPA toured the room with Administrator and observe the temperature was comfortable and air was blowing out of the vent, but the resident window was open. Administrator stated the resident do not like to close the window.

The investigation reveals the following: Regarding "Facility staff not responding in a timely manner ", it is alleged that the resident called for help, but the facility staff never came. During the tour LPA tested the call button and all was in working condition. During the test the facility staff responded in less than a min over the intercom. The administrator stated when a resident pushes the call button the front desk staff will first respond over the intercom and then send out a care staff. If the care staff is busy, they will let the resident know that they are next in line or another care staff will assist. If the resident is having an emergency, the administrator or another staff will respond right away. 2/2 staff stated they have always responded to the residents and have not heard the residents complain about not getting assistance. 7/7 residents confirmed the facility staff has always responded in a timely manner when they need assistance.

Based on LPA's observation, interviews and file review the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Ana Giron and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC9099 (FAS) - (06/04)

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