198204399-6-19-2024-11-AS-UCOL-D74VYN-20240712165122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 06/19/2024
Date Signed: 06/19/2024 04:59:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
05/31/2024 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240531123105

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: 66	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Administrator Maria Bravo		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident sustained an unexplained fracture while in care.
Resident is being physically abused while in care.
Staff leave residents soiled for an extended period of time.

INVESTIGATION FINDINGS:

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On 06/19/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Administrator Maria Bravo and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA Cloyd reviewed records and video recording, and interviewed eight (8) residents and six (6) staff members which included the Administrator, Wellness Coordinator, Lead MedTech, Caregiver/MedTech, and (2) Caregivers. On 06/03/2024 around 09:00AM Licensing Program Analyst (LPA) Jose Calderon initiated an investigation with Villa Redondo Care Home for the allegations listed above. Today’s complaint investigation was conducted face to face with Administrator Maria Bravo A1. During today’s visit, LPA Jose Calderon conducted face to face with Administrator Maria Bravo A1. LPA Calderon and Administrator A1 toured the facility including all common areas.

Continue to LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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 11-AS-20240531123105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 06/19/2024

NARRATIVE

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LPA Calderon requested copies of the following: Copy of R1-R3 facility file to include Staff and Resident Roster, Needs and Service plan, SIR reports for current complaint and 3 months. MAR for 3 months, physician report admission agreement, Hospital records, admission agreement for R1-R3. It has been determined that the complaint of “Personal Rights” will require further investigation.

Allegation(s):
Resident sustained an unexplained fracture while in care.

The investigation revealed the following: Regarding the allegation "Resident sustained an unexplained fracture while in care,” it is being alleged that Resident #1 (R1) sustained an unknown broken arm a few months ago. On 06/19/24, LPA observed that R1 was not in a cast nor sling but complained of pain. Record review revealed R1 was sent to the hospital on 07/13/23 for a swollen arm. R1 returned to the facility the same day with new prescription and a fracture to the left arm. Interview with the Wellness Coordinator indicated that R1 was placed on hospice shortly after the arm swelling and hospice tended to the arm fracture. Record review revealed that R1 was admitted to hospice on 07/20/23. Interview with the Administrator indicated that the cause of arm swelling was unknown and that in 2023 R1 would get up unassisted, (unwitnessed) fall, and unable to recall the incident. Regarding the allegation “Resident sustained an unexplained fracture while in care,” based on observation, record review, and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation(s):
Resident is being physically abused while in care.

The investigation revealed the following: Regarding the allegation "Resident is being physically abused while in care,” it is being alleged Resident #1 (R1) had a red bruise on R1’s leg due to a kick and R1 was pushed into a wall. Record review revealed that R1 hit R1’s leg on R1’s wheelchair on 05/23/24 and Hospice provided care on the same day. Interview with MedTech indicated that R1 was startled by her knock on the door and R1 quickly lifted R1’s leg and hit R1’s wheelchair.

Continue to LIC9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240531123105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 06/19/2024

NARRATIVE

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MedTech indicated that R1 sleeps diagonally. LPA Cloyd observed R1 laying diagonally. Staff interviews indicated that they have not witnessed residents being physically abused. Interview with the Administrator indicated that on 05/23/24, a resident reported R1 being pushed into a wall in the dining room hallway. LPA observed the 05/23/24 hallway video recording with the Administrator and did not observe R1 being pushed into a wall in the dining room hallway. Regarding the allegation “Resident is being physically abused while in care,” based on observation, record review, and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation(s):
Staff leave residents soiled for an extended period of time.

The investigation revealed the following: Regarding the allegation "Staff leave residents soiled for an extended period of time,” it is being alleged that residents go hours without being changed. It is being alleged that residents remain soiled for hours until someone decides to check on them. Staff interviews, including the Administrator, indicated that residents are checked every 1 - 2 hours. Six (6) out of six (6) resident interviews indicated that they have not received incontinence complaints from other residents. Two (2) out of three (3) residents indicated that they are changed every two hours. Regarding the allegation “Staff leave residents soiled for an extended period of time,” based on interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Administrator Maria Bravo.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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