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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 02/02/2022
Date Signed: 02/02/2022 04:09:58 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
12/17/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20211217113142
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
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Maria BravoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident wasn’t provided his medication as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/02/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced subsequent visit
Regarding the allegations above. LPA was met by Facility Administrator Maria Bravo, and the purpose of
the visit was explained.
Investigation consisted of the following: Physical Plant Tour, Interviews conducted with residents in care/Staff.

Regarding Allegation “Medication not being provided as prescribed”
Interviews with residents in Care Resident 2,3,4 Generally stated that they are being provided
Their medications as prescribed. The medications for Residents 2,3,4 medications are delivered to the facility, by the pharmacy, and stored in locked medication room. Record Review revealed reporting party (RP) /Resident 1 (R1) is self-responsible for picking up their own medications from their pharmacy of choice and providing it to the facility. Interviews revealed that R1 declined to use Delivery Pharmacy services offered by pharmacy due to being able to drive to desired location. R1 stated that due to them working, sometimes they take the prescribed medications for the day or next few days before giving it to the facility to store.

Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20211217113142
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: 02/02/2022
NARRATIVE
1
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8
9
10
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14
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Interviews with Med- tech revealed that all medications are given as prescribed and tracked on the Medication Administration Record. Interviews with Med Tech Revealed that there is only one resident who is self- responsible and picks up their own medications.
Based on interviews conducted, observation, and record review the Department 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 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
LIC9099 (FAS) - (06/04)
Page: 2 of 2