198204972-9-6-2024-11-AS-UCOL-D9PUSB-20241003155004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 09/06/2024
Date Signed: 09/06/2024 11:55:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/05/2024 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20240905103943

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: 116	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Administrator - Sandra Lopez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not assist resident with scheduling their medical appointments

INVESTIGATION FINDINGS:

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On 09/06/2024 at around 08:00 AM Licensing Program Analyst (LPA) Leandro conducted a complaint investigation regarding the allegation listed above. LPA met with Administrator Sandra Lopez and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA interviewed Resident 1 (R1), and 2 out of 35 staff. LPA reviewed Personnel Report, Register of Facility Residents, Plan of Operation, Medical Appointment Binders, and R1’s records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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-20240905103943

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 09/06/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Staff did not assist resident with scheduling their medical appointments,” it is being alleged that R1 has requested assistance in scheduling medical appointments for physical therapy per doctor’s orders, and a mammogram, but staff refused to assist R1 in scheduling their medical appointments. Interviews conducted reveal the following: R1 states “I have no idea” who schedules my appointments, I get free rides to go see my doctors. R1 goes on to explain that someone picks them up and someone schedules all her medical appointments, but she does not know who they are. 2 out of 2 staff interviews conducted indicated that R1’s medical provider has not requested physical therapy or a mammogram for R1, they have also tried assisting her with scheduling physical therapy, but R1’s insurance no longer cover physical therapy (R1 will have to pay out of pocket if they wish to receive physical therapy). Records review reveal the following: medical documentation for R1 does not state that R1 needs/requires physical therapy or a mammogram (the words physical therapy or mammogram are not mentioned in R1’s recent hospital visits nor medical appointments). R1 had an appointment with her primary physician on 08/15/2024 and 07/10/2024. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No citations were issued.

An exit interview was conducted, and a copy of this report was left with the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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