198204079-5-9-2023-11-AS-SCIS-CT2223-20230621170004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204079
Report Date: 05/08/2023
Date Signed: 05/09/2023 09:30:34 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20230503152517

FACILITY NAME:	SPRING SENIOR ASSISTED LIVING		FACILITY NUMBER:	198204079
ADMINISTRATOR:	CRAIG WEECH		FACILITY TYPE:	740
ADDRESS:	20900 EARL STREET		TELEPHONE:	(310) 370-3594
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	51	CENSUS: 31	DATE:	05/08/2023
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	VICKY SOTELO		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not provide resident with an invoice for services

INVESTIGATION FINDINGS:

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On 05/8/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. LPA was greeted and assisted by Activity Director Vicky Sotelo. LPA explained the purpose of the visit.

The investigation consists of the following: LPA Montoya interviewed one staff (S2) and one resident (R1) in person. LPA interviewed one staff (S1) and one witness (W1) by telephone. LPA obtained and reviewed R1’s service records and other pertinent records. A tour of the facility was conducted.

Report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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 11-AS-20230503152517

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SPRING SENIOR ASSISTED LIVING	FACILITY NUMBER: 198204079
	VISIT DATE: 05/08/2023

NARRATIVE

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INVESTIGATIONS REVEALED:

Based on LPA’s records review, R1 was admitted to the facility on 2/8/2023. R1’s daughter is the designated responsible person with a Power of Attorney for R1.

Regarding allegation: Staff did not provide resident with statements for services.

It was reported that resident has been at this facility for the last two months and has not received any invoices or bills (statements) for resident's care and services. R1 has not received a copy of the admission agreement as well. LPA Montoya conducted interviews with two staff (S1-S2), one resident (R1) and one witness (W1). Interviews with S1 and W1 revealed that R1’s daughter is the POA and in charge of handling R1’s finances. S1 and W1 stated the facility provided R1’s POA with a copy of the Admission Agreement and statements for rent and other services. W1 stated on 3/25/23 at 11:30 am, R1, R1’s daughter and S3 had a meeting via telephone and discussed R1’s care, services and fees. Per LPA’s review of the facility statements for R1, the charges for rent, care and other services are indicated in detail. R1’s payments made to the facility are also included in the statement. Based on gathered information, there is no sufficient evidence to corroborate the above allegation.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the above allegation is Unsubstantiated.

An exit interview was conducted with Activity Coordinator Vicky Sotelo and a copy of the report was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC9099 (FAS) - (06/04)

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