198320032-6-26-2022-11-AS-JHAD-CFUVJ9-20220629162822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320032
Report Date: 06/26/2022
Date Signed: 06/26/2022 12:02:55 PM

Unsubstantiated

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
05/06/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220506111328

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: 113	DATE:	06/26/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Robert May, Executive Director		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility is not following covid protocols.

INVESTIGATION FINDINGS:

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THIS AMENDED LIC 9099 SUPERSEDES REPORT DATED 05/16/22.Licensing Program Analyst (LPA) Ana Soto conducted subsequent complaint visit to deliver amended findings for the allegation listed above. Today’s complaint investigation was conducted with Robert May, Executive Director.

The investigation consisted of following: Interviews and record reviews. LPA toured the entire Haven Unit, which consisited of the following: lounge room, Director of memory care office, dining room, activity room, tv room, balcony/patio. LPA Soto interviewed Executive Director, Director of Nursing, Supervisor of Haven Unit, S#4 - S#9, R#1 - R#6. LPA received the following documents on 05/16/2022, Resident Roster and Staff roster for Haven Unit.

Based on the LPA's investigation, the investigation revealed the following.
For Allegation – Facility is not following covid protocols. Interviews conducted with Executive Director,

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: 06/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2022

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-20220506111328

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: 06/26/2022

NARRATIVE

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Director of Nursing, Haven Supervisor, S#4 - S#9, and R#1 - R#6, all were in agreement that the facility followed the latest Covid 19 protocols. To ensure that safety of all staff and residents in the facility. They were testing resident's every day and testing staff weekly. The facility had signs posted for the positive residents, they used the red poster. For the residents that where symptomatic and/or in quarantine, they used the yellow poster. For the negative residents, they used the green posters. The residents where all separated from each other depending on their tests and/or symptoms. The positive residents and negative resident where never co-mingled. The facility had 2 rooms designated for positive residents (activity and TV rooms.) The negative residents also had 2 rooms designated for them, (Lounge room and dining room.) The facility had enough PPE's for the staff at all times. The staff would always donning their full PPE's with the Covid Positive residents. When working with the Covid negative residents, they always wore masks and wash their hands. They would un-donning their full PPE's and put new masks on, and wash their hands when leaving the Red Zone and put new mask and wash hand again before entering the green zone. The facility is still in the yellow zone and under Outbreak status with DPH. All residents are out of quarantine, awaiting on DPH to release them from the outbreak status. The DPH performed their own site visit on Friday 05/13/22, they did not have any Covid 19 concern or issues with the facility. The DPH was satisfied with the facility, they were following all their guidelines. LPA found that the facility followed the latest CCLD Covid -19 protocols, from (PIN 22-09- ASC.) The facility followed the following PIN's: PIN 21-43-ASC, Mitigation Plan. The facility was following their mitigation plan and had it posted in the facility. PIN 21-38-ASC-Fit testing, all the staff was fit tested for N95 masks. PIN 21-53 – ASC, Required vaccinations and boosters. All the staff was vaccinated and had booster shots too.

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 exit interview was conducted with, Robert May, Executive Director, and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2022

LIC9099 (FAS) - (06/04)

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