198204950-9-30-2020-11-AS-EMAZ-BU6MQC-20201007094831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 09/29/2020
Date Signed: 09/30/2020 07:44:23 AM

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2020 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200821101916

FACILITY NAME:	CARSON SENIOR ASSISTED LIVING		FACILITY NUMBER:	198204950
ADMINISTRATOR:	SHOLOM GOLDMAN		FACILITY TYPE:	740
ADDRESS:	345 EAST CARSON STREET		TELEPHONE:	(310) 830-4010
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	230	CENSUS: 146	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Ginger Enriquez		TIME COMPLETED:	03:37 PM

ALLEGATION(S):

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Facility staff falsified resident's records
Facility staff did not safeguard resident's personal property
Facility staff is not allowing residents to have private phone calls

INVESTIGATION FINDINGS:

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On 09/29/20 Licensing Program Analyst, LPA/Ernand Dabuet initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Ginger Enriquez/Administrator at this facility.

The investigation consisted of the following: Interviews conducted with staff, residents, case manager, and family member. Copies were obtained of current staff/resident roster, (R1's) pre-placement appraisal, physician’s report, emergency contact information, needs and service plan, and medication records. A plant inspection of the facility was conducted.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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-20200821101916

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
MONTERY PARK, CA 91754

FACILITY NAME: CARSON SENIOR ASSISTED LIVING	FACILITY NUMBER: 198204950
	VISIT DATE: 09/29/2020

NARRATIVE

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Allegation: Facility staff falsified resident’s records
Facility staff did not safeguard resident’s personal property
Facility staff is not allowing residents to have private phone calls

The Department conducted interviews with staff, residents, and witnesses along with service records reviewed and found there is no evidence to corroborate the allegations mentioned above.

It is alleged facility staff falsified (R1’s) resident’s records. An interview with the resident (R1) revealed the allegation was not against this facility, rather it is for her medical insurance company. (R1) states she felt her personal information was falsified by her medical insurance company and not the facility. (R1) states she had discussed the matter with her insurance company as well with their fraud department. Interviews were conducted with staff (S1-S4) all indicated that it is their utmost responsibility to ensure that all resident’s service records are safeguarded. (S1-S4) reports they have not observed staff members falsifying any records. Interviews with residents (R2-R10) revealed residents felt confident in allowing management staff to have access to their personal information and they have no immediate concerns.

It is alleged this facility did not safeguard (R1’s) personal property. An interview with (R1) claims whenever she is not present in her room, her bags of personal items are rearranged or the contents inside the bags are missing. (R1) admits she is not the only one who has a key to her room, as management and the housekeeping staff also have copies. When asked what items were missing, (R1) was unable able to identify or able to provide dates when it happened. Though (R1) claims she had photographs on her cellular phone; the photos were erased as her phone was hacked. An interview with (S2) states she is assigned to clean (R1’s) room and has no knowledge of personal items missing. (S2) reported according to management’s orders, (R1) had requested special accommodation not to have her room serviced without her present to supervise. (S2) states housekeeping staff abides by the house rules and will announce their presence prior to entering each resident room. An interview with the administrator (W1) of Gardena Retirement Center (R1’s) former residence, (R1) had suspected a housekeeping staff of taking several her personal items. (W1) reports an internal investigation was conducted and found no merit to (R1’s) claim. An interview with (S1) states each resident is responsible for safeguarding their own personal property in their rooms. In addition, management does offer a safe to residents for their valuables in the business office by request.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200821101916

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
MONTERY PARK, CA 91754

FACILITY NAME: CARSON SENIOR ASSISTED LIVING	FACILITY NUMBER: 198204950
	VISIT DATE: 09/29/2020

NARRATIVE

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According to (S1), (R1) had prior concerns with roommates over privacy and personal items tampered. During an interview with (R7) a former roommate, she reported (R1) had accused her of taking (R1's) Bible. (R7) claims her name was written inside the book and found there is no evidence of her accusation. (S1) claims due to (R1's) concerns, management took actions to accommodate (R1) by transferring her from four (4) shared rooms to now one (1) private room within a year residency at this facility.

It is alleged this facility is not allowing (R1) to have private phone calls. An interview with (R1) states she is unable to have private conversations on her personal cellular phone. (R1) states she gets noise interference while she is on a call and assumes someone is hacking her calls to retrieve her information. (R1) states she is not certain who is hacking her phone device but does acknowledge it may also be a poor connection while on a private call. (R1) is unable to give detailed information to support her assertion as she claims it is a suspicion on her part. An interview with (S1-S4) all claimed that residents are given their privacy to incoming calls. Aside from residents' personal cellular phones, residents have access to a wireless phone located in the medication room and can utilize remotely within the facility. Each resident is given their privacy to accept in any location of the facility and that no staff member interferes with any calls. Interviews were conducted with (R2-R10) all claim they have no concerns conducting private communications while inside the facility.

The Department interviewed (R1’s) former administrator, case manager, and family member (W1-W3) all claimed (R1) has the propensity to be over concern and overly suspicious of others. All of them have stated that (R1) has the inclination to reprise these same allegations from the past.

Based on information gathered, the Department did not find sufficient evidence to support the allegations: “Facility staff falsified resident’s records”, “Facility staff did not safeguard resident’s personal property”, “Facility staff is not allowing residents to have private phone calls”.

Although the allegations may have happened or are valid, there is not enough preponderance of evidence to prove the alleged allegations are valid did or did not occur. Therefore, the allegations are "unsubstantiated.”

A telephonic exit interview was conducted with Ginger Enriquez, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

LIC9099 (FAS) - (06/04)

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