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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204399
Report Date: 02/02/2022
Date Signed: 02/02/2022 04:16:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 HOMEFACILITY NUMBER:
198204399
ADMINISTRATOR:MARIA BRAVOFACILITY TYPE:
740
ADDRESS:237 REDONDO AVENUETELEPHONE:
(562) 434-9931
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:80CENSUS: 46DATE:
02/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Maria BravoTIME COMPLETED:
04:00 PM
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On 02/02/22 Licensing Program Analyst (LPA) Jade Jordan conducted a Case Management in conjunction to complaint 11-AS-20211217113142 Resident alleged that they were injured in care, from a dresser provided by the facility, that fell on them in July 2021.

According to RP/R1 this was un-witnessed, but reported to Facility Management.

Record Review Revealed that on 07/03/21 R1 had an un-witnessed fall at 6am. Resident reported that they were walking to the bathroom and slipped off of the doorknob of the bathroom door, and fell onto dresser. Resident claimed they had an 8 out of 10 pain level. Facility staff offered to send resident to hospital. Resident refused to accept emergency services. PRN Tylenol was given and continued to monitor.

Later that after noon 3pm Resident was transported to LB Memorial Hospital. Resident returned same day 9:50 pm, with no new medications or physician directions. Unusual Incident report was made on 07/07/21, and received By LPA Jordan. Administrator stated that they took the dresser out of resident’s room and replaced it with a new one.

Health and Safety check were conducted with residents in care. Interviews with residents revealed that all residents generally declined having been caused an injury by facility furniture, and that no dressers have fallen on them.

An Exit interview conducted, a copy of this report was provided. No Citations were issued.

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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