198204972-2-16-2021-11-AS-MVAO-BYBT5Y-20210217132619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 02/12/2021
Date Signed: 02/16/2021 02:53:48 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
01/14/2021 and conducted by Evaluator Jey Cardenas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210114144449

FACILITY NAME:	ROSECRANS VILLA RESIDENTIAL CARE		FACILITY NUMBER:	198204972
ADMINISTRATOR:	SANDRA LOPEZ		FACILITY TYPE:	740
ADDRESS:	14110 CORDARY AVENUE		TELEPHONE:	(310) 675-9163
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	135	CENSUS: 109	DATE:	02/12/2021
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Sandra Lopez		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Licensee did not seek appropriate medical care for resident
Facility staff intimidated resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jey Cardenas conducted a subsequent complaint visit to deliver findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint visit was conducted telephonically with administrator, Sandra Lopez.

During the course of the investigation LPA interviewed administrator, Sandra Lopez, nine (9) residents (R1-R9), and nine (9) staff (S1-S9). LPA toured physical plant, and obtained additional resident documentation pertinent to the allegation

It is alleged that on 1/13/2021 R1 told Reporting Party (RP) that resident “started a new medication and medicine made tongue swelling.” R1 requested that staff call ambulance, staff refused and told R1 that if ambulance was called "they would kick R1 out or take resident to jail".
See continued LIC9099-C on page #2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

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-20210114144449

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: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 02/12/2021

NARRATIVE

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Continued LIC9099-C page #2

The investigation revealed the following: For allegation: Licensee did not seek appropriate medical care for resident. On 1/25/2021 LPA interviewed Sandra who indicates that facility has not denied a resident’s request to go to the hospital. Facility protocol is to assess residents and send out to hospital for appropriate medical care. If residents insist on going to hospital nurse will send resident.

On 1/25/2021 LPA Cardenas interviewed R1 who indicated that “facility is very nice and has no complaints.” LPA asked R1 if resident had recently asked to go to the hospital and request was denied? R1 indicates “never.” LPA asked if there was a recent medical emergency and resident didn’t feel well; resident indicates no. LPA interviewed R2-R9, eight (8) residents indicated that facility seeks appropriate medical care. When residents request to go to the hospital, facility will send them out. Staff #1-9 indicates that they have never witnessed an incident where residents were denied request to go to hospital. Staff indicate none of the residents have told them that staff denied request to go to hospital. On 2/10/2021 LPA reviewed Medication Administration Records (MAR) for R1, LPA observed that resident had been taking “new” medication in December and January.

For allegation: Facility staff intimidated resident; LPA asked Sandra if any staff has been written up for misconduct? Not treating residents with respect nor dignity, Sandra states no. LPA asked if she has been made aware of staff threatening and intimidating residents, she states no. LPA interviewed R1 and asked if staff are nice, residents states “staff is nice”. LPA asked if any staff has been mean to R1, residents states “never”. LPA asked if staff has ever been intimidated or threatened, R1 states “never”. LPA asked if recently staff has told R1 that resident is going to get kicked out or taken to jail? Resident indicates “no”. Eight (8) out of nine (9) residents indicated that facility staff are nice to them, haven’t threatened them, nor intimidated them. All nine (9) staff interviewed indicated that they treat residents with respect and dignity. S6 indicates facility prohibits staff from talking back and being abusive towards residents. “Even if residents are difficult, we understand because they have a mental health and that’s why they are here.”

Although the allegations may have happened or is valid, after interviews with residents and staff, and record review there is not a preponderance of evidence to prove the alleged violations(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited, Exit Interview conducted, and report given facility representative.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

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