198204399-9-13-2021-11-AS-MCAA-C7ZVZH-20211021165247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 09/13/2021
Date Signed: 09/13/2021 03:50:06 PM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20210909154125

FACILITY NAME:	VILLA REDONDO CARE HOME		FACILITY NUMBER:	198204399
ADMINISTRATOR:	MARIA BRAVO		FACILITY TYPE:	740
ADDRESS:	237 REDONDO AVENUE		TELEPHONE:	(562) 434-9931
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90803
CAPACITY:	80	CENSUS: 47	DATE:	09/13/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maria Bravo		TIME COMPLETED:	11:28 AM

ALLEGATION(S):

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Staff do not treat residents with respect
Staff did not ensure faciltiy was free from pests
Staff are not refilling residents medication timley
Resident room has mold

INVESTIGATION FINDINGS:

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On 09/13/21 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced complaint visit regarding the allegations above. LPA met with Facility Administrator Maria Bravo, and the purpose
of the visit was explained. The investigation consisted of Physical Plant tour, Observation of Random rooms, Interviews conducted With residents in care/Staff, and obtained documents pertinent related to the allegations.

Regarding Allegation: Facility Staff does not treat residents with respect. LPA interviewed 10 percent of Resident in Care all generally stated that they have No issue with staff, and feel that staff are treating them with respect. Upon LPA’s observation LPA did not observe any interaction deemed Disrespectful between residents in care, and staff. Interview with Administrator revealed that there were no complaints regarding staff being rude or disrespectful to residents. Therefore, based on LPA interviews the LPA finds that Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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-20210909154125

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 09/13/2021

NARRATIVE

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Regarding Allegation: Staff did not ensure facility was free from pests.

LPA’s interviews with Residents in Care revealed that all generally stated that they have not seen any mice within the facility. Some residents stated that they have seen one or Two cockroaches. LPA Sampled Random rooms on Floors 2, and 3 and did not observe any mice or cockroaches in any resident room, hallways, walkways or elevators. Record Reviews shows that the facility has a pest control to treat the facility on a bi-weekly basis to ensure facility is keep free of pest infestation. Therefore; Based on Lpa Interviews, Observation, Record Review the LPA finds that Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur therefore the allegation is unsubstantiated

Regarding Allegation: Staff are not refilling resident’s medication timely.

LPA interview's with residents in Care stated that all are receiving their medications and have not received untimely refills. LPA interview Med Tech and Med tech stated all refills have been timely except one resident who picks up their own medication. Per Faciltys communication log dated 09/08/21, CVS pharmacy was contacted for resident refill of medication. Resident picks up own of prescriptions, due to not using facility contracted Guardian pharmacy. Cvs Pharmacy let resident know that the MD had authorized refill on 09/08/21, but would not be dispensed by the pharmacy, until 09/10/21. Medication was picked up by resident on 09/10/21. Therefore: Based on Lpa Interviews, and Record Review the LPA finds that Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210909154125

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 09/13/2021

NARRATIVE

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Regarding Allegation: Resident room has mold.

Lpa along with administrator Observed room numbers 214, and 219. Administrator stated that room 214 had a leak in the bathroom from the room above, due to the water faucet being left on. The Leak ran through the bathroom ceiling fan/vent of room 214. No water damage was caused to the room. The Room Has carpet, and no water spots or damage were observed in the room by the LPA. LPA did not observe any scent of mold in the room or bathroom. LPA interviewed Residents in care, all generally stated that they did not have any water damage to their rooms, or mold. Therefore: Based on Lpa Interviews, and observation, the LPA finds that Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted and a copy of this report was provided.

No citations were issued during this visit.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

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