198204950-7-18-2021-11-AS-EMAZ-C5JSV7-20210803141212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 07/16/2021
Date Signed: 07/18/2021 06:42:28 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2020 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201214161442

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: 176	DATE:	07/16/2021
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	GINGER ENIQUEZ		TIME COMPLETED:	03:29 PM

ALLEGATION(S):

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Resident's needs are not being met.
Resident left in soiled clothing for a long period of time.

INVESTIGATION FINDINGS:

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On 07/16/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit at this facility. LPA met with Ginger Enriquez, Administrator, and explained the purpose of today's visit is to conduct additional interviews and to deliver findings.

The investigation consisted of the following: LPA interviewed Ginger Enriquez. Interviews were conducted with four (4) staff, three (3) witnesses, and fourteen (14) residents. LPA inspected the facility. LPA reviewed copies of service records concerning (R1) along with the current staff/resident roster and other documents in association with the allegation. A reveiw of (R1's) medical records and police report were performed.

Evaluation Report continues on LIC9099-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: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

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-20201214161442

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: 07/16/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident's needs are not being met.
Resident left in soiled clothing for a long period of time.

It is alleged the staff is not meeting resident #1 (R-1’s) needs and was left in soiled clothing for an extended period. The complainant (W-1) claims (R-1) needs were neglected and were left in soiled clothing for more than 24 hours. An interview with staff #1-#4 (S1-S4) all argues this claim. The administrator (S-1) stated caregiver’s responsibility is to assist the residents with activities of daily living (ADL). Caregivers could be responsible for up to 10 residents at one time. When a caregiver is notified of a diaper or bedding change, the caregiver will address the matter within 30 minutes. Moreover, caregivers are trained to use aided equipment to help maneuver residents who are heavy to clean them. (S-1) claims in the situation with (R-1) who was ambulatory and was medically evaluated as independent when admitted on 01/13/20. (S-1) claims that (R-1) was being assisted by caregivers only as required and when requested by (R-1). (S2-S4) reported there were occasions when (R-1) refused assistance with toileting, diaper changes, or medications when it was readily available. (S2-S4) all verified residents are monitored at least three times during each shift within the eight hours. (S2-S4) further asserted, it would be improbable to have (R-1) in soiled clothing for more than 24 hours by all three work shifts. Interviews with residents #2-#11 (R-2-R-11) all claimed they had no problems with the staff and found them to be attentive and responsive to their care and needs. Residents #12-#14 (R12-R14) had concerns with how infrequently the staff monitor or changed their diapers. However, a review of “Resident ADL 2-Hour Check List ” disputes their statements. Nonetheless, (R2-R14) were all unanimous to state the staff has not left any resident in soiled clothing for 24 hours. Furthermore, (R2-R14) felt their care and supervision are being met and were complimentary of the staff. An interview with witness #3 (W-3) power of attorney to (R-1) claims, (R-1) was at the lowest level of care, which meant the resident can do all her own (ADLs). (W-3) included the staff at this facility did their best. The staff went above and beyond what was expected and that (R-1) was not charged fees for the extra services performed. (W-3) reported that (R-1) had multiple health issues that caused her daily discomfort and found it was more natural to blame others that were willing to help. There were no statements from (R-1) as she was not available for an interview.

Evaluation Report continues on LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201214161442

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: 07/16/2021

NARRATIVE

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The Department conducted a review of the Los Angeles County Sheriff’s Department report (W-2) and had determined no victims of elder abuse were found.

The Department’s investigation consisted of an inspection of the facility, observation, review of (R-1’s) service records, incident report, ADL Check List Log, Medical Records, along with interviews of staff, residents, and witnesses were conducted and found no evidence to support the allegations mentioned above.

Based on information gathered, the Department did not find sufficient evidence to support the allegations: "Resident's needs are not being met", "Resident left in soiled clothing for a long period of time".

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.”

No deficiencies were cited.

An exit interview was conducted with Ginger Enriquez, and a hard copy was provided via email.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC9099 (FAS) - (06/04)

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