198205203-11-16-2023-11-AS-MVAO-CZ4TKU-20240102134827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205203
Report Date: 11/15/2023
Date Signed: 11/16/2023 07:35:18 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20231108115320

FACILITY NAME:	GLOBAL ELDERLY CARE FACILITY INC.		FACILITY NUMBER:	198205203
ADMINISTRATOR:	TERESITA CRUZ BAUTISTA		FACILITY TYPE:	740
ADDRESS:	2009 253RD PL.		TELEPHONE:	(424) 250-9710
CITY:	LOMITA	STATE: CA	ZIP CODE:	90717
CAPACITY:	6	CENSUS: 3	DATE:	11/15/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	JOEL MORALES		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff speaks inappropriately to resident in care.

INVESTIGATION FINDINGS:

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On 11/15/2023 at 10:30 AM, Licensing program analyst (LPA) Lourdes Montoya conducted an initial 10-day complaint visit to this facility to investigate the allegation mentioned above. LPA met with House Manager Maricel Campbell and LPA explained the purpose of today’s visit. Staff Joel Morales arrived later and joined the visit.

The investigation consisted of the following: LPA Montoya toured the facility. LPA obtained copies of the following: Staff roster, resident roster and R1’s service records which include Admission Agreement, Physician’s Report, Appraisal/Needs and Services Plan and other pertinent records. LPA interviewed two staff (S1-S2), one resident (R2), and one witness (W1) at the facility. LPA attempted to interview two residents (R3-R4) but R3 could not maintain a proper conversation and R4 was sleeping. LPA interviewed one resident (R1) and two witnesses (W2-W3) via telephone.

REPORT CONTINUED IN LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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-20231108115320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLOBAL ELDERLY CARE FACILITY INC.	FACILITY NUMBER: 198205203
	VISIT DATE: 11/15/2023

NARRATIVE

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INVESTIGATIONS REVEALED:

Allegation: Staff speaks inappropriately to resident in care.

According to SOC 341, a staff was very angry toward R1, and it hurt R1.

On 11/15/2023, LPA interviewed two out of four residents (R1-R2). R1 stated a staff (S1) and R1 had disagreements. R1 stated S1 told R1 “I am tired of pleasing you. You would die if you continued to refuse to eat”. R1 stated S1 speaks to R1 with a raised voice and sounds angry for unknown reasons. R2 stated S1 has a lot of responsibilities in the home and sometimes S1 becomes frustrated but S1 takes good care of the residents. R2 stated R2 heard R1 and S1 argued on several occasions and S1 yelled at R1 because R1 refused to eat.

On 11/15/2023, LPA interviewed two out of two staff (S1-S2). S1 and S2 denied that staff speaks inappropriately to resident in care.

On 11/15/2023, LPA interviewed three witnesses (W1-W3). W2 stated W2 heard from R1 that R1 and S1 had disagreements. W3 stated W3 heard from R1 that R1 and S1 had arguments. However, W1 denied the allegation.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; Therefore, the allegation of: "Staff speaks inappropriately to resident in care” is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Health and Safety Code), the following deficiency has been observed and citation issued (ref. LIC 9099D).

Exit interview was conducted and a copy of the report was provided to Staff Joel Morales.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231108115320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLOBAL ELDERLY CARE FACILITY INC.	FACILITY NUMBER: 198205203
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/01/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Staff Joel Morales and House Manager Maricel Campbell agreed to review the section of Title 22 cited herein. Administrator will conduct an in-service training and will submit a POC to CCLD via email to lourdes.montoya@dss.ca.gov by the POC due date 12/1/2023.
	8 9 10 11 12 13 14	Based on interviews conducted, two residents (R1 & R2) confirmed that S1 speaks inappropriately to R1. Two witnesses (W2 and W3) supported the allegation with their statements that R1 and S1 had arguments. This poses a potential health, safety and/or personal rights to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC9099 (FAS) - (06/04)

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