198320032-7-30-2021-11-AS-JHAD-C5UV28-20210813160240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320032
Report Date: 07/22/2021
Date Signed: 07/30/2021 05:59:07 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2021 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210526163508

FACILITY NAME:	KENSINGTON REDONDO BEACH, THE		FACILITY NUMBER:	198320032
ADMINISTRATOR:	MAY, ROBERT		FACILITY TYPE:	740
ADDRESS:	801 S PACIFICA COAST HIGHWAY		TELEPHONE:	(424) 241-2064
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90277
CAPACITY:	132	CENSUS: 95	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Robert May, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not ensure resident's toileting needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint visit to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Robet May, the facility Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 06/03/21, LPA Soto conducted interviews with Director of Nursing Julie Lacey. The LPA also requested and received copies of the following documents: Resident roster, Staff roster, R#1 -R#3 -Physician's Report, Medication list, Care Plan, Pendant report (call time,) S#3 - S#5 files (App Employment, Trainings, Health Screening) LPA also toured lobby,1st floor hallway and lounge, 1st floor common bathroom, dining room, TV lounge room, Activity Room, Executive Director's office, rooms 103, 114B, & 204B. 07/20/21, LPA Soto conducted interviews with Robert May (Executive director), Raquel Martinez (Human Resources Manager), S#4 - S#9, R#1 - R#10. Toured entire facility. The LPA also requested and received copies of the following documents. Resident and Staff rosters and Admissions agreement (R#1.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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-20210526163508

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
MONTEREY PARK, CA 91754

FACILITY NAME: KENSINGTON REDONDO BEACH, THE	FACILITY NUMBER: 198320032
	VISIT DATE: 07/22/2021

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following.

For Allegation #1 – Staff do not ensure resident's toileting needs are met. Interview with Robert May, stated that R#1 was a respite resident (temporary resident.) R#1 had a temporary physical disability and was being help with therapy, in order, for R#1 to get better and move to another facility or home. Interviews with Julie lacey, Rachael Martinez, and S#4 – S#9, stated that R#1 had a temporary physical disability, but R#1 was doing therapy and getting better. R#1 did not need help with incontinence problem. R#1 could go to the bathroom on R#1 own. R#1 could walk around with a cane and did not need help with any ADL’s. Interviews with R#2 – R#10, stated that the needs are being met, care givers helped them with everything they need and request. Their toileting needs are being met. The staff are very nice and helpful. LPA Soto reviewed R#1 file and indicating that R#1 was temporary in the facility and was being helped with R#1 temporary physical disability. The interviews and reports reviewed did not concur with the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

An interview was conducted with Robert May, Executive Director and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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