198204950-7-13-2021-11-AS-EMAZ-C5JT7A-20210803142826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204950
Report Date: 07/13/2021
Date Signed: 07/13/2021 07:30:57 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
07/09/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210709130912

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:	DATE:	07/13/2021
		UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	GINGER ENRIQUEZ		TIME COMPLETED:	04:01 PM

ALLEGATION(S):

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Resident was left on the ground for an extended period after falling.
Resident care needs are not being met.

INVESTIGATION FINDINGS:

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On 07/13/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility. LPA met with Ginger Enriquez, Administrator, and explained the purpose of today's visit is to conduct interviews and to deliver findings.

The investigation consisted of the following: LPA interviewed Ginger Enriquez. Interviews were conducted with five (4) staff, (1) witnesses, and (10) residents. LPA inspected the facility. LPA reveiwed service records concerning (R-1) along with the current staff/resident roster and other documents in association with the allegations.

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: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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-20210709130912

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: 07/13/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Resident was left on the ground for an extended period after falling.
It is alleged the staff neglected (R-1) for an extended period after a fall. The complainant claims (R-1) was left for an extended period of approximately 1-3 hours on 07/08/21 in her room located on the second floor. An interview with (R-1) claims she had fallen while transferring from bed to her wheelchair. Later, she stated she fell in the bathroom. (R-1) reported the incident happened approximately at 11 am. Then again claimed it happened early morning when it was still dark. (R-1) states she received assistance from staff within 30 minutes. Afterwards, (R-1) stated there was no assistance from staff and she managed to crawl to the first floor on hands and knees for help. An interview with staff #1-#4 (S1-S4) all dispute (R-1)'s claim on how the incident occurred. Staff #2 (S-2) reports that she was the first staff on the scene to discovered (R-1) laying on the ground by her bed and not in the bathroom. (S2- S4) all reported the incident happened around 6:30 am and not during mid-day as (R-1) first claimed. (S1-S4) all had consistent accounts of the incident. Moreover, (R1) received immediate assistance with 911 dispatched. (R-1) was taken for medical evaluation. (S1-S4) claim the proper emergency procedures were applied and that Community Care Licensing and Ombudsman were notified. Interviews with residents (R2-R10) second floor residents, all claim that staff are attentive to their care and have not encountered any type of neglect. (R2-R10) included in their statements that they did not hear (R-1) call out for help during early morning hours on 07/08/21. A particular statement from (R-3) claims he conducts his daily morning walking exercises in the hallways of the second floor would have overheard (R-1) call for assistance. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Resident care needs are not being met.
It is alleged the staff is not meeting (R-1)'s care needs. The complainant reported (R-1) appeared unkempt and unpleasant smell when she was admitted to the hospital on 07/08/21. An interview with (R-1) disputes this claim. (R-1) states that her appearance was satisfactory and that she is happy with the care that is provided by the staff. (R-1) claims as a resident at this facility, she has no problems here. Interviews with (S1-S4) all dispute this allegation and states that (R-1) has never seen unkempt or presented herself with an unpleasant smell. (S-1) claims that (R-1) is independent, however, needs assistance with bathing. (S-1) states there may be some occasions that (R-1) may choose not to bathe and that a sponge bath is available

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: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210709130912

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: 07/13/2021

NARRATIVE

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as an option when (R-1) refuses to shower. This technique is used by the staff to maintain comfort and dignity for (R-1). A review of the "shower notes" log verified that services were performed weekly. Interviews conducted with residents #1-#10 (R1-R10) all indicate they are completely satisfied with the care and services provided by the staff at this facility and have not felt negelected. During the interview, the Department observed (R-1) appeared presentable in appearance and did not exude any malodorous odor. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations: "Resident was left on the ground for an extended period after falling", "Resident care needs are not being met".

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.

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: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC9099 (FAS) - (06/04)

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