198204950-12-27-2021-11-AS-MVAO-CBXT8N-20220224133038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 12/14/2021
Date Signed: 12/27/2021 08:19:15 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
12/06/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211206102736

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: 171	DATE:	12/14/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	GINGER ENRIQUEZ		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Food services are inadequate
Facility is dirty.
Resident's bedding is not being charged regularly.
Residents are not being provided activities.
Resident is being forced to stay in their bed for an extended period.
Resident’s bathing needs are not being met.
Resident’s diapering needs are not being met.
Resident call buttons are not being responded to on time.
Facility is understaffed.
Resident is not being provided physical therapy as prescribed by their physician.

INVESTIGATION FINDINGS:

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On 12/14/21, Licensing Program Analysts (LPAs) Ernand Dabuet and Gail Johnson conducted a subsequent unannounced complaint visit at this facility, LPA was greeted by Administrator Ginger Enriquez. LPA explained the purpose of today's inspection visit is to complete addtional staff interview and deliver findings.

The investigation consisted of the following: LPA obtained copies of the roster for residents and staff. Interviews were conducted with Resident #1-#10 (R1-R10), staff #1-#7 (S1-S7), and witnesses #1-#4 (W1-W4). Reviewed (R1's) service records and other pertinent documents pertinent to the allegations

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: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

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 6

Control Number 11-AS-20211206102736

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: 12/14/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility is dirty.
Resident's bedding is not being changed regularly.
The complainant claims that resident #1 (R1’s) carpet is dirty and soiled. An interview with (R1) reports that her carpeting requires some deep cleaning aside from the daily vacuum. (R1) claims that her room carpet is dirty. (R1) claims that housekeepers are performing daily duties with dusting and vacuuming and does a fairly good job, however, due to her allergies the carpeting is dusty and soiled and requires additional deep cleaning, (R1) claims that staff is aware of the condition, but did not know the name of staff or when she informed the staff. The Department inspected (R1)’s room and found the room to be maintained in order and dust-free. The carpeting showed some areas of light discoloration considered normal wear and tear but did not observe any dark soiled spots. An interview with housekeeping supervisor witness #3 (W3) claims that residents’ rooms are cleaned daily to ensure that it is sanitary. (W3) claims additional requirements have been in place to ensure the facility and all resident’s rooms are in sanitary condition due to COVID-19. Extra duties have been arranged by management and housekeeping staff to maintain the facility is a safe and clean environment. (W3) included in a statement, (R1's) carpet was steamed cleaned on 10/27/21. The Department in four (4) months has completed ten (10) plant inspections at this facility. The Department observed the facility to be clean and maintained in order. During the visit on 12/09/21 and other prior visits, the Department has regularly observed housekeeping, janitorial, and maintenance services are performed. Interviews completed with residents #2-#10 (R2-R10) gave no evidence of concerns and did not think the facility is dirty.

It is alleged that (R1’s) bedding is not changed more frequently. The complainant states that staff has neglected to change the bedding for (R1). (R1) claims that the staff does change her bedding and would prefer to have it done more frequently like twice a week. (R1) states on 12/04/04 and 12/05/21, her bedding sheets were not changed and were left soiled, and claims staff #2 was working a double shift and did not have time to change the sheets. An interview with staff #2-#3 (S2-S3) both assisted with care and services for (R1) during these dates dispute this claim. (S2) claims that the housekeeping staff is responsible for changing the sheets and that caregivers will assist when housekeeping is not available. (S2) disputes working a double shift during these dates and did not observe (R1’s) the bedsheets soiled. (S3) also confirms working on these dates did not observe (R1’s) sheets left soiled.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 11-AS-20211206102736

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: 12/14/2021

NARRATIVE

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The administrator staff #1 (S1) claims according to (R1’s) Admissions Agreement is granted with a clean bed and bath weekly, or as often as needed. (S1) reports according to her agreement, it is changed at least a minimum of once a week and that staff has never neglected to change the sheets when required. Interviews performed with residents #2-#10 (R2-R10) found no issues with bedsheets not being replaced more often or left soiled.

Allegation: Food services are inadequate.
It is alleged resident #1 (R1) is not fed with quality food and portion sizes are not enough. The complainant claims that (R1) is fed with sandwiches on soggy bread and rarely will get a hot meal and that the meals lack nutritional value. During an interview with (R1), she claims she is not on any special diet and is unaware that alternative options are available. (R1) claims she is aware of the monthly menu but has not been given a single copy for a year since the start of her residency. (R1) also claims that she made a kitchen staff aware of her issues. However, (R1) claims she is not to verify the name of the staff. An interview with the head cook staff #4 (S4) claims that all residents receive three (3) meals and snacks daily. (S4) claims options are listed on the monthly menu distributed to all residents. According to (S4), the options are available upon request and comments that (R1) has no history of placing special requests with any kitchen staff on record. (S4) also verified that food provided is approved by Nutrition Menu Solutions and that meals are provided at appropriate food temperature when served to residents. An interview with activity coordinator staff #5 (S5) refutes that (R1) is not provided with the monthly Carson Chronicle in which it details the daily activities and food menu for the month. Interviews conducted with residents #2-#10 (R2-R10) found no proof of issues with food services being inadequate.

Allegation: Resident’s bathing needs are not being met.
Resident’s diapering needs are not being met.
It is alleged that resident #1 (R1’s) bathing needs are not being met. The complainant states (R1) has not received bathing in 2-3 weeks as required. An interview with (R1) claims she does not get showers but is given sponge baths scheduled weekly on Sunday and Wednesday at 11 am or 1 pm. (R1) comments that (S1 and S2) both are aware that she has not had any sponge bath in several weeks. Interviews completed with (S1 and S2) both argue this claim and report (R1) is given weekly bathing services. A review of (R1’s) Shower Log disputes (R1’s) claim. The record shows (R1) was provided weekly bathing and it showed no gaps during in dates that would indicate services were not performed. Interviews completed with residents #2-#10 (R2-R10) found no problems with residents’ bathing needs are not met.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20211206102736

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: 12/14/2021

NARRATIVE

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The complainant states resident #1 (R1's) diapering needs are not met. It is reported (R1) is not getting changed regularly. An interview with (R1) asserts she does get changed at 4:30 am; 1:30 pm and 6 pm at least three (3) times daily. (R1) claims in her own opinion that there is not enough staff to handle the diapering requirements. In an interview with staff #1-#3 (S1-S3) all expressed no references have been brought to their attention and that (R1's) diapers are changed daily or as needed. The Department inspected (R1’s) ADL 2-Hour Check List where it confirms that (R1) is monitored and changed as scheduled. The records indicated no discrepancies. Interviews conducted with residents #2-#10 (R2-R10) found no evidence to support the allegation diapering needs are not met.

Allegation: Resident’s call buttons are not being responded to in a timely manner.
Facility is understaffed.
The complainant states resident #1 (R1’s) call button is not being responded to promptly. In an interview with (R1), she claims on 12/04/21 she was waiting for a caregiver to respond to her call. (R1) says she can not recall what she needed at the time and that the front desk took approximately one hour to an hour and a half to respond. (R1) remarks a staff eventually came and (R1) can not recall the name or the staff. During an interview with staff #2-#3 (S2-S3) both denied ever getting a dispatched call for (R1). Both staff worked during the shift and do not recall (R1) requiring services placed with the call button. An interview with staff #6 (S6) who worked the front desk on 12/04/21 denies that (R1) ever put in a request for assistance. (S6) says staff is rerouted and will answer timely within no more than five minutes. The Department tested the (R1’s) call button on 12/09/21 at 12:21 pm on a busy time of the day and found (R1’s) call button in working condition, and the front desk answered in "one minute and twenty-nine seconds". The Department did random testing of residents’ call buttons from rooms #1; #32, and #164 and found all of them to be working properly. The staff responded within less than 2 minutes with each call. Interviews conducted with residents #2-#10 (R2-R10) all claim to have no concerns with the call button or with staff responds timely.

It is alleged the facility is understaffed. The complainant states resident #1 (R1) requests from staff takes long time. (R1) was questioned the time, date, or name of the staff and failed to provide any of the information. Likewise, (R1) did not know what is considered enough staff working for each shift that would be sufficient. (R1) comments that the staff is meeting her hygiene needs when questioned. An interview with the administrator staff #1 (S1), argues that (R1’s) needs never go unnoticed as she is included in the Assisted

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20211206102736

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: 12/14/2021

NARRATIVE

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Daily Living and 2 Hour Checklist monitored as often as required when she uses her call button. According to (S1), three (3) caregivers for the morning shift; (3) caregivers for the afternoon shift, and two (2) for the graveyard shift. Each caregiver is assigned to up to ten (10) combined assisted and independent residents. (S1) stated the remaining staff are also crossed trained to assist as caregivers if required. An inspection of ADL and the 2 Hour Checklist discloses services are being performed every two hours with (R1). Interviews conducted with residents #2-#10 (R2-R10) found no proof to support the facility is understaffed.

Allegation: Resident is not being provided physical therapy as prescribed by their physician.
The complainant states resident #1 (R1) is provided physical therapy. The complainant communicated (R1) has not received physical therapy as required. An interview with (R1) asserts she was not cognizant of how the home health system worked nor was she aware this type of service must be referred by her primary physician. (R1) says she did not know that the facility was in coordination. (R1) argues this is a misunderstanding and was not acquainted with how the system operated. An interview with the home health provider witness #2 (W2) reasons that (R1) was discharged for her last physical therapy on 12/02/21. (R1) is scheduled for 12/11/21 with her primary physician for a physical evaluation. (W2) states the referral will be determined by (R1's) physician if the service will continue for more additional sessions. In an interview with staff #1 (S1), claims we do not restrict residents of therapy services. The facility has no control over what residents' physicians authorize. Interviews conducted with residents #2-#10 (R2-R10) found no evidence to support the facility refuses services prescribed by their primary physicians.

Allegation: Residents are not being provided activities.
Resident is being forced to stay in their bed for an extended period of time.
The complainant alleges resident #1 (R1) is not provided with daily activities. An interview with (R1) claims she is not able to et out of her room and be out to socialize due to her non-ambulatory status. (R1) claims there are no activities for anyone to do at the facility. (R1) claims she is knowledgeable there is an activities coordinator on staff but has not spoken with the staff. An interview with activities coordinator staff #5 (S5) is familiar with (R1's) non-ambulatory condition. (S5) it does not stop her from including (R1) in daily activities. (S5) reports (R1) does not want to participate as she prefers being in her room watching television. (S5) daily activities are listed in detail in the monthly calendar starting at 9:30 am through 3:00 pm daily. (S5) expresses when (R1) refuses to participate in the activity room, she will bring to her room the activity such as backgammon, bagatelle, checkerboard, checkers, chess, playing cards, dominoes, and salon nails.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20211206102736

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: 12/14/2021

NARRATIVE

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Interviews with staff #1-#3 all confirmed that oftentimes, (R1) is the one who refuses to participate in any daily activities and prefers to be in her room left alone watching television. Interviews completed with residents #2-#10 (R2-R10) found no evidence to support the allegation and stated activities are available daily for everyone to participate.

It is alleged resident #1 (R1) is forced to stay in bed for an extended period. The complaint states there is nothing for (R1) to do at the facility and is forced to be in bed. (R1) reports that she is not being forced to stay in bed and that no one is restraining her in bed. (R1) claims there is nothing for her to do she is not taken out of her room for three (3) weeks. Interviews with staff #1-#3 all reiterated that (R1) is the one who will refuse to socialize with other residents with activities and rather be in her room left alone watching television. (S1) claims there is no merit to her charge that (R1) has not been let out of her room for three (3) weeks. (S1) claims ever since witness #1 (W1) has halted her in-person visits due to some disagreement with (R1) has been unhappy and dissatisfied with her living conditions. The Department conducted a follow-up interview with (R1) on 12/09/21, and she admitted that she is not happy living at this facility and wants to leave. She stated she will agree to do anything to make it happen. Interviews conducted with residents #2-#10 (R2-R10) found no evidence to support residents who are unintended to stay in their beds for an extended time.

Based on information gathered, an inspection of the facility, observation, analysis of (R-1)'s service records, and interviews conducted, the Department found no evidence to support all ten (10) allegations listed on this complaint report.

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.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021

LIC9099 (FAS) - (06/04)

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