198204972-10-31-2024-11-AS-UCOL-DB8QFD-20241121110743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:14:56 PM

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
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 the facility was free of pests
Staff did not safeguard resident's personal belongings

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 toured resident rooms and the kitchen area. The department gathered facility 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: 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 the facility was free of pests”, it is being alleged that the facility has roaches, and the facility is doing nothing to address the pest infestation. Interviews conducted revealed the following: 7 out of 10 residents indicated that have seen roaches in the facility but not a lot of them. 3 out of 10 residents indicated that they have not seen roaches in the facility. 10 out of 10 staff indicated: that they have seen roaches in the facility, the facility has very few roaches, and the facility hired a pest control company and they come to the facility on a regular basis to fumigate common areas and rooms. Invoices from a Pest Control Company dated from 07/2024 to 10/2024 indicated that they come to the facility three times per month; one visit is dedicated for the kitchen; two visits are dedicated to fumigating 10 rooms and common areas. On a monthly basis the Pest Control Company fumigates the kitchen area, 20 rooms, and common areas. 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.

Regarding the allegation “Staff did not safeguard resident's personal belongings”, it is being alleged that staff threw away resident’s food. Interviews conducted revealed the following: 8 out of 10 residents indicated that staff has not thrown away their personal food items. 9 out of 10 interviews conducted indicated that when staff clean residents’ bedrooms they do throwaway food that has gone bad for example gone moldy, smells bad, and looks inedible. 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: 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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