198204950-6-11-2021-11-AS-EMAZ-C5JTBH-20210803143511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 06/11/2021
Date Signed: 06/11/2021 12:35:06 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
06/03/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210603142200

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: 174	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	GINGER ENRIQUEZ		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not meeting resident's hygiene needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 06/11/21, 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 addtional interviews with residents and to deliver findings.

The investigation consisted of the following: LPA interviewed Ginger Enriquez. Interviews were conducted with five (5) staff, two (2) witnesses, and residents. LPA conducted a tour of the facility. LPA requested copies of service records concerning (R1) along with the current staff/resident roster and other documents in association to the allegation.

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: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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 3

Control Number 11-AS-20210603142200

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: 06/11/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not meeting the resident’s hygiene needs.

It is alleged the staff are not meeting resident #1 (R1’s) hygiene needs. Witness #1 (W1) claims (R1) has not been showered for a week. (W1) claims (R1) is scheduled showers twice a week on Wednesday and Saturday, and no records were found during a visit on 06/02/21. An interview with staff #1-#5 (S1-S5) all denied the allegation. An interview with (R1’s) assigned caregivers (S2-S4) all verified that (R1) is provided showers twice a week on Wednesday and Saturday. (S2-S4) reported (R1) occasionally refuses showers due to anxiety or discomfort issues and will decline to cooperate with staff. The facility used the sponge bath technique to keep (R1) clean and odor-free as an option when (R1) refuses to shower. This technique is used by the staff to maintain comfort and dignity for (R1). (S1-S5) all verified the services were performed and noted as evidence on (R1’s) “shower schedule notes”.

An interview (R1) claims she has not been showered for (16) days. When (R1) was questioned for dates and time, (R1) was unable to provide an accurate date and time when alleged incidents occurred. During the interview, (R1) would wander in and out the order of sequence when explaining the conditions that happened. Although (R1) claimed no showers in (16) days, (R1) did not appear disheveled in appearance or presented with an unpleasant odor.

Interviews were conducted with residents #2-#10 report the staff provides adequate services and is complimentary of the staff. Interviews with witnesses #2-#3 (W2-W3) both gave conflicting accounts but then were both unisons when describing (R1’s) appearance was not disarrayed. The Department inspected the facilities’ shower schedule notes and found all the necessary information were entered and that records were maintained and accurate. Records revealed (R1) is being provided bathing assistance two times weekly as noted on (R1’s) Admissions Agreement and Appraisal/Needs and Services Plan.

The Department’s investigation consisted of an inspection of the facility, observation, review of (R1’s) service records, incident report, shower schedule notes, and interviews conducted and found no evidence to support the allegation mentioned above.

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: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210603142200

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: 06/11/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on information gathered, the Department did not find sufficient evidence to support the allegation “Staff are not meeting resident’s hygiene needs.”

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

No deficiencies were cited during this inspection visit.

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: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3