198204950-10-16-2020-11-AS-EMAZ-BVQ2Q8-20201125163530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 10/15/2020
Date Signed: 10/16/2020 06:32:02 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
10/05/2020 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201005164222

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:	10/15/2020
		UNANNOUNCED	TIME BEGAN:	11:18 AM
MET WITH:	Ginger Enriquez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff not meeting resident's needs.
Staff not allowing resident to have visitors.

INVESTIGATION FINDINGS:

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On 10/15/20 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, resident, and case managers. Copies were obtained of current staff/resident roster, (R1's) pre-placement appraisal, physician’s report, emergency contact information, needs and service plan, and elder abuse police report. 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: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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-20201005164222

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: 10/15/2020

NARRATIVE

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Allegation: Staff not meeting resident's needs.
Staff not allowing residents to have visitors.

The Department conducted interviews with staff, resident, and witnesses along with service records, and elder abuse police report were reviewed and found there is no evidence to corroborate the allegations mentioned above.

It is alleged the staff is not meeting (R1’s) needs. (R1) was admitted to this facility on 08/27/18. The State of California pays for (R1’s) Care. (R1) receives the benefits of meals and shelter and that (R1) qualified for a state program to be housed at this facility. (R1) does not have any source of income, family member, power of attorney nor conservator appointed. A non-profit organization appointed a social worker (W2) to assist with his placement, counseling, supportive care, and advocacy and has been overseeing his case for two years.

According to the complainant (W1), (R1’s) needs are not being met when the resident is not allowed visits at this facility. (W1) states a visit was not allowed on 10/02/20 to have a face to face interaction with (R1) and was asked to stay outside of the facility to conduct business. (W1) claims she was uncertain if the SSA-1696 form was signed by (R1). An interview with staff (S1-S3) all verified that the form was indeed signed by (R1) with no staff assisted. According to the administrator Ginger Enriquez, (W1) was accommodated during the visit on 10/02/20 and was not denied having access to (R1). (W1) claims the main objective was for (R1) to be enrolled in a program to assist seniors to pay their bills. Enriquez claims she responded to the emails and phone calls from (W1) and that management was in no way obstructing or preventing (R1) in qualifying for this program. Enriquez added that she was in constant contact with (W2) to assist in getting (R1) enrolled in the program. The Department was not able to gather information related to these allegations from (R1) due to his medical condition. The Department reviewed email communications between parties from 09/14/20 through10/02/20 and found that (W1) had forwarded the form to the incorrect caseworker (W3) which caused delays and confusion in procurement of (R1’s) signature. (W2) claims this facility has been very cooperative, supportive, and responsive to all of (R1’s) needs and services. (W2) reports this a misunderstanding and that a complaint should have never even have been filed and that this facility should not be liable. (W2) added this is a rushed in judgment as all of the parties involved were working collectively to ensure that (R1) would receive benefits from this program. (W1) admitted she sent the necessary form to the incorrect caseworker as noted in the email communications. In closing, (W2) explains she was able to obtain signature on the form SSA -1696 from (R1) on 10/02/20 visit and that was main objective.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201005164222

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: 10/15/2020

NARRATIVE

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It’s is alleged the staff is not allowing (R1) to have visitors. (W1) claims she was not allowed to have face to face interaction with (R1) during her visit at this facility on 10/02/20. According to Enriquez, (W1) did not specify that the visit required a face to face interaction with (R1) and that forms just required signatures. Enriquez explains if a request was communicated by (W1) to have a face to face visit, an alternate means of communications such as video calls and online communications would have gladly granted as an alternative option. (S1-S3) claims due to COVID-19 and the measures set in place by Community Care Licensing, The Department of Public Health and Centers for Disease Control and Prevention mandated additional steps to ensure the health and safety of resident and staff from outside contact resulting in many cases suspending in-person visitation, except when medically necessary or essential to the care of the resident. Such as home health, hospice care, and end of life. Enriquez states that the health and safety of residents and staff are of utmost importance, but also considers all the resident’s rights as well.

The Department obtained a copy of a non-criminal elder abuse report from Carson Sheriff’s Station dated 10/06/20. The report states based on information gathered there is no crime was found. Based on the Department’s observation, interviews, and a review of service/police records that were conducted, the Department found there is no evidence to support the allegation mentioned above.

Based on information gathered, the Department did not find sufficient evidence to support the allegations: “Staff not meeting resident's needs” and “Staff not allowing resident to have visitors.”

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: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

LIC9099 (FAS) - (06/04)

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