198204399-5-15-2025-11-AS-JHAD-DHQLJ4-20250617084721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 05/15/2025
Date Signed: 05/15/2025 11:57:05 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2025 and conducted by Evaluator Zina Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250506153328

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: 50	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Maria Bravo, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility is refusing to accept resident back from skilled nursing facility.
Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 05/15/2025 at 8:30am, LPA initiated a conducted a subsequent complaint visit at this facility to deliver the complaint findings. During today’s visit, LPA met with Maria Bravo (Administrator) and explained the purpose of the visit.

The investigation consisted of the following: On 05/08/2025, LPA interviewed the Administrator (A1), Staff #1 – Staff #4 (S1–S4), & Resident #2 (R2). On 05/15/2025, LPA interviewed Resident (R1), Resident #3 (R3) – Resident #7 (R7). On 05/08/2025, LPA reviewed the documents of the resident roster & staff roster (received on 05/08), all of the documents for R1 such as the Admission Agreement (dated 04/01/2025), LIC 601 Identification & Emergency Information (dated 04/01/2025), LIC 602 Physician Report for RCFE (dated 03/08/2025), LIC 603, LIC 613-C Personal Rights (dated 04/01/2024) LIC 621 Client Resident Personal Property (dated 04/01/2024), (13) LIC 624 Unusual Incident/Injury Report (October 2024 – March 2025), Order Summary Report (dated 05/08/2025), Medication Administration Records (April - May 2025 - printed 05/08/2025), Preplacement Appraisal Information (dated 05/8/2025) , & Individualized Service Plan (dated 04/01/2024).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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-20250506153328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 05/15/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Facility is refusing to accept resident back from skilled nursing facility.
It was alleged R1 was admitted to the hospital on 03/16/2025 and subsequently transferred to a skilled nursing facility (SNF). It is alleged upon discharge from the SNF the facility refused to accept the resident back to the Villa Redondo.

On 05/08/2025 between the hours of 2:04pm -2:47pm, LPA interviewed Staff #1(S1) – Staff #4 (S4) regarding the allegation. On 05/15/2025 between the hours of 9:24am – 10:39am, LPA interviewed Staff #5 (S5) – Staff #7 (S7) regarding the allegation. Staff #1 (S1) – Staff #7 (S7) were unaware of the allegation. S1 – S7 interviews indicated general awareness that returning residents must meet reassessment and care level requirements. No staff reported being involved in or aware of any resident being permanently denied re-entry in the past. 7 out of 7 staff denied the allegation of facility not allowing the resident to return to the facility from Skilled Nursing Facility (SNF).

On 05/14/2025 at 11:51am, LPA received interviewed with the Administrator (A1) via email (document dated 05/08/2025) regarding the above allegation.

On 05/08/2025, according to the Administrator (A1) Maria Bravo, stated the resident’s return was dependent upon progress in physical therapy and the results of a reassessment. Documentation and correspondence confirmed that the resident was scheduled to return on 05/08/2025. On 05/14, Administrator stated R1 returned to the facility on 05/09.

On 05/08/2025 between the hours of 2:25pm – 2:28pm, LPA interviewed Resident #2 (R2). On 05/14/2025 between the hours of 9:37am – 10:20am, LPA interviewed Resident #1 (R1), Resident #3 (R3) – Resident # 8 (R8). (1) out of (8) residents interviewed confirmed the allegation; (7) out of (8) residents denied the allegation.

On 05/15/2025 at 10:08am, LPA observed R1 has returned to the facility.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250506153328

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 05/15/2025

NARRATIVE

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Allegation: Staff did not safeguard resident's personal belongings.

It is being alleged that upon moving into the facility Resident #1 (R1) states she had a manual blue wheelchair with duct tape that is missing.

On 05/14/2025 at 11:51am, LPA received interviewed question answers from the Administrator (A1) via email (document dated 05/08/2025) regarding the above allegation. A1 was unaware of the allegation.

On 05/08/2025, according to the Administrator (A1) Maria Bravo, stated the resident refused to complete the LIC 621: Client/Resident Personal Property and Valuables form, thus declining documentation of personal belongings. A1 stated no inventory of the resident’s belongings was documented at the time of departure to the SNF. A1 stated the resident may have confused her wheelchair with another due to similar descriptions. The facility offered an alternative wheelchair, which the resident declined.

On 05/08/2025 between the hours of 2:04pm -2:47pm, LPA interviewed Staff #1(S1) – Staff #4 (S4) and on 05/15/2025, between the hours of 9:24am – 10:39am, LPA interviewed Staff #5 (S1)– Staff #7 (S7) regarding the allegation. Staff #1 (S1) – Staff #7 (S7) were unaware of the allegation. S1 – S7 interviews indicated that residents’ personal items are typically left in their rooms and that the room is locked after staff assist the resident’s roommate.

On 05/08/2025 between 2:25pm – 2:28pm and 05/14/2025 9:37am - 10:20am, LPA interviewed Residents #1(R1) – Resident #8 (R8). 3 out of 8 residents interviewed confirmed the allegation; 5 out of 8 out residents denied the allegation.

On 05/15/2028 between the hours 8:45am – 9:00am, LPA conducted a record review and observed LIC 621 Client/Resident Personal Property and Valuables. Resident #1 (R1) declined to complete the document by listing all their personal belongings.

On 05/08/2025, between the hours of 2:25pm – 2:28pm, LPA conducted a tour of the resident room and observe Resident (R1) has a red electric wheelchair located near R1 bed located in her shared room.

Based on observation, interviews, and record reviews, there is not enough 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, therefore, the allegation is unsubstantiated.

Exit interview conducted with Maria Bravo (Administrator) & copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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