198320032-5-23-2022-11-AS-JHAD-CJQRA6-20220929125036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320032
Report Date: 05/23/2022
Date Signed: 05/23/2022 02:50:02 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
05/16/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220516103707

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: 22	DATE:	05/23/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Robert May, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff denied resident family visits.
Staff denied resident other communication with family.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Robert May, Executive Director

The investigation consisted of following: Interviews and Record reviews. On 05/23/22, LPA Soto interviewed Executive Director, Robert May, Dementia Unit Manager, via telephone Keith Serle, R#1 – R#3. LPA Soto received the following documents on 05/23/22: Resident Roster, Staff Schedule, Physician’s report, Admission agreement, Notarized Durable Power of Attorney – Doc#528464788 pgs. 1-12, California Advance Health Care Directive -Doc#528465153 pgs. 1-9 dated 09/08/18, notarization dated: 09/17/19.

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: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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-20220516103707

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: 05/23/2022

NARRATIVE

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

For Allegation – Staff denied resident family visits. Interviews with Executive Director and Dementia Unit Manager stated that R1 was a POA and R1’s POA advised the facility that certain family members are not allowed to visit R1. The facility is abiding by POA’s request. When other family members that are not on the POA approved list to visit, the facility calls POA to see if those individuals can visit with R1. If POA denies visitation for those individuals, the facility denies the visitors request to visit via in-person. Interview with Dementia Unit Manager stated that according to the POA, they are having a legal court date in June 2022, to finalize R1 situation. Interviews with R#1 -R#3, where not able to communicate with LPA. Due to their advance mental condition. LPA reviewed Notarized Durable Power of Attorney, which grants POA to make decisions on behave of R1. The interviews and records review did not concur with the above allegation.

Allegation 2 - Staff denied resident other communication with family. Interviews with Executive Director and Dementia Unit Manager stated that R1 was a POA and R1’s POA advised the facility that certain family members are not allowed to visit R1. The facility is abiding by POA’s request. When other family members that are not on the POA approved list to visit, the facility calls POA to see if those individuals can visit with R1. If POA denies visitation for those individuals, the facility denies the visitors request to visit via in-person, telephone, written, and/or virtual. Interview with Dementia Unit Manager stated that according to the POA, they are having a legal court date in June 2022, to finalize R1 situation. Interviews with R#1 -R#3, where not able to communicate with LPA. Due to their advance mental condition. LPA reviewed Notarized Durable Power of Attorney, which grants POA to make decisions on behave of R1. The interviews and records review did not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit 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: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC9099 (FAS) - (06/04)

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