198204950-9-25-2021-11-AS-EMAZ-C7CTKJ-20210930144802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 09/22/2021
Date Signed: 09/25/2021 01:00:47 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
08/31/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210831083515

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: 172	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Ginger Enriquez		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff yelled at the resident.
Staff are not assisting the resident with hygiene.
Staff hit the residents.
Facility is dirty.
Facility is unkept.
Facility has cockroaches.

INVESTIGATION FINDINGS:

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On 09/22/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. LPA met with the administrator Ginger Enriquez and explained the purpose of today's visit is to gather information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: LPA inquired questions relevant to the nature of the complaint. An interview with the administrator and (6) staff, (9) residents in which included resident #1 (R1) from Arbor Hall and (2) witnesses. LPA reviewed (R1)'s service records and other pertinent documents associated with this complaint. A tour fo the entire facility were conducted on 08/31/21 and 09/21/21.

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: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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 4

Control Number 11-AS-20210831083515

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: 09/22/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff yelled at the resident.
It is alleged staff yelled at resident #1 (R1). The complainant reported she was unable to provide the name or names of staff who yelled at (R1), the complainant did not have a time, date, or the cause of the incident. The Department interviewed (R1) and was not given a name of a staff or any additional information. (R1) states she did not appreciate being supervised by staff. Although, (R1) never claimed a staff ever raised his/her voice to her when being told or requested to do something by staff. (R1) states she has observed staff treating residents unkindly. Again, (R1) was not able to provide names of staff or residents involved. In an interview with (R2), a resident who shares a room with (R1) states she has not experienced any staff being disrespectful to her or her roommate. Additional interviews with residents (R3-R10) all asserted the staff are courteous and respectful and have not observed or experience any staff holler at them or other residents. An interview with (S1-S6) claim that they have not observed any staff member verbally mistreated residents. (S1-S6) all staff addresses communication with residents are conducted professionally and properly. The administrator informed the Department that staff must complete Employee Training which consists of a variety of topics such as Resident's Rights, Dementia Care, Communications/Resident Relations, and Cultural Competencies/Sensitivity Issue are just some that are covered. Based on the information gather, there’s no evidence to collaborate the allegation mentioned above.

Allegation: Staff is not assisting the resident with hygiene.
It is alleged the staff is not assisting with resident #1 (R1)’s hygiene. The complainant was unable to disclose the time or date of hygiene not met. The complainant was uncertain if the (R1) had addressed her needs with staff. A review of (R1)’s service records indicates that (R1) is capable of providing self-care. During an interview with (R1), she disclosed that she was able to bathe, groom, dress, attend to her toileting needs and did not need assistance with her hygiene. (R1) states that she has observed residents not being provided their hygiene needs. However, (R1) was unable to provide names, dates, times, or room numbers of staff or residents involved. (R1) later contradicted the claim she is not assisted with hygiene by stating the staff is responsive to her needs when she requests assistance. During an interview with (R1) on 09/21/21, she appeared presentable and did appear disheveled or exude any unpleasant scent.

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: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210831083515

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: 09/22/2021

NARRATIVE

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Interviews with (R2-R10) all indicated the staff is completely satisfied with the care and services provided by the staff at this facility and have not felt neglected. The Department reviewed Arbor Hall Resident Incontinent (2) hour check and Daily Shower Logs and was able to verify services are being provided. Based on the information gather, there’s no evidence to support the allegation mentioned above.

Allegation: Staff hit the residents.
Details provided indicated staff hit residents. The complainant did not disclose the name/information of the staff. The complainant did not provide any additional information on when the abuse happened or if resident #1 (R1) was the victim of the physical abuse. An interview with (R1) claims she has never encountered physical abuse from staff. (R1) did claim she witness a resident from Arbor Hall who was physically violated by a male staff member. Once more, (R1) unable to provide names, room number, time, and date when the incident occurred. The only information the (R1) was able to provide was the ethnicity of both staff and residents. A review of resident and staff roster along with staff schedule disputes (R1)’s description of staff and resident involved in the abuse. Interviews with (R2-R10) all reported they have not experienced or witness any residents subjected to any abuse. Interviews with (S1-S6) all claim this accusation is inaccurate. The staff conducts daily body checks of residents and if any questionable or suspicious marks or injuries would be reported and investigated. All of the staff interviewed declared that they treat their residents with dignity and respect and upholds themselves as professional employees with ethical standards. Based on the information gather, there’s no evidence to support the allegation mentioned above.

Allegation: Facility is dirty; Facility is unkept; Facility has cockroaches
It is alleged this facility is unclean, untidy, and has cockroaches. The complainant did not specify a particular area of the facility, date, or time when issues were observed. The complainant is uncertain if any of these issues were even addressed with management. The Department in the past six (6) weeks has conducted eight (8) plant inspections at this facility. The Department observed the facility to be clean and maintained in order. During the visits on 09/21/21 and other prior visits, the Department has regularly observed housekeeping, janitorial, and maintenance services being conducted. An interview with (S5-S6) both expressed that they continue to ensure that the facility is in healthful conditions due to COVID-19 and extra work has been arranged by management and housekeeping staff to ensure the facility is a safe and sanitary environment for staff and residents daily.

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: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210831083515

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: 09/22/2021

NARRATIVE

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The residents (R2-R10) reports they are pleased with the upkeep of the facility and state their rooms and common areas are not neglected. They all added (R2-R10) they have not observed the facility with any type of pest including cockroaches. Based on interviews and observation, there is no evidence to back the allegations mentioned above.

Further claims from Long Term Ombudsman (W2) who conducted their investigation to these allegations affirm there is no credibility to any of these accusations.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, and interviews conducted and found no evidence to support the allegations: "Staff yelled at the resident", "Staff are not assisting the resident with hygiene", "Staff hit the residents", "Facility is dirty", "Facility is unkept", and "Facility has cockroaches."

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies cited during this visit.

An exit interview was conducted with Ginger Enriquez and a copy of the report was provided by email.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

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