198204972-10-31-2024-11-AS-UCOL-DB8QFC-20241121110742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:15:59 PM

Unfounded

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
10/30/2024 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20241030091044

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: 112	DATE:	10/31/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator - Sandra Lopez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure resident's doctor received resident's medical records

INVESTIGATION FINDINGS:

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On 10/31/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced complaint visit at this facility. CCLD staff was greeted by Administrator Sandra Lopez. CCLD staff explained the purpose of this visit.

The investigation consisted of the following:
On 10/31/2024, The department interviewed 10 out of 112 residents and 6 out of 35 staff. The department
gathered facility records.

Unfounded

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: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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-20241030091044

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: 10/31/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Staff did not ensure resident's doctor received resident's medical records”, it is being alleged that resident’s doctor requested resident’s medical history from facility’s doctor and resident’s doctor has not received resident’s medical history. Interviews conducted revealed the following: The facility Administrator indicated that the facility does not have a physician on payroll. Records reviewed revealed the following: There is no physician on the current “Personnel Report” dated “04/01/24”. Regarding the allegation, the allegation is unfounded because the allegation is false, could not have happened, and/or is without a reasonable basis.

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: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

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