198204399-11-23-2021-11-AS-MCAA-C9NREY-20211213115816

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 11/23/2021
Date Signed: 11/23/2021 01:14:23 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
11/19/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20211119154159

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: 46	DATE:	11/23/2021
		UNANNOUNCED	TIME BEGAN:	11:52 AM
MET WITH:	Maria Bravo		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident's personal belongings are not being safeguarded.

INVESTIGATION FINDINGS:

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On 11/23/21 Licensing Program Analyst (LPA) Jade Jordan Conducted an Unannouced visit to Villa Redondo, regarding the Allegation Above. LPA was met by Facility Administrator Maria Bravo, and the purpose of the visit was explained.

The investigation consisted of the following: Resident Roster, Staff Roster, Personal Inventory, Supplemental documents.

Regarding the allegation : Personal Belongings are not being safeguarded.
Interviews with the Administrator revealed that Resident (R1) has not resided in the facility since 09/31/21, and moved to a New facility. R1 was self responsible, and paid rent with checks. The facility does not assist with cash resources. R1 was admitted to the facility effective 08/01/19, and signed to refused documentation of inventory a personal property to indicate what items R1 would be bringing. The LPA also reviewed R1's Record of Resident safeguarded Cash Resources, and the line list did not indicated any cash funds reported.

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: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

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-20211119154159

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: 11/23/2021

NARRATIVE

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Interview's revealed that R1 passed away, after leaving to another facility.

Based on LPA Interviews, Record Review, 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: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

LIC9099 (FAS) - (06/04)

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