198320032-9-26-2022-11-AS-JHAD-CJQRA5-20220929125035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320032
Report Date: 09/26/2022
Date Signed: 09/26/2022 11:44:58 AM

Substantiated

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:	09/26/2022
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Robert May, Executive Director		TIME COMPLETED:	12:00 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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This amended report supersedes report dated 05/23/22. Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigationto deliver findings and decisions 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.

Substantiated

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: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-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: 09/26/2022

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, but it does not give the POA the right to restrict visitors. R1’ can have visitors as long as R1 allows visitors to visit. PIN 21-48, states that POA do not have the right to restrict visitors for R1. Interviews and records review does 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, but it does not give the POA the right to restrict communication with family. R1 can have communication with family if R1 excepts the family. PIN 21-48, states that POA do not have the right to restrict communication with family for R1. Interviews and records review does concur with the above allegation

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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: 09/26/2022

NARRATIVE

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Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies and issued citations.

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: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/07/2022 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	87468.1(a)(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This was not met as evidence by:	1 2 3 4 5 6 7	Executive Director to proivde a letter of outcome of family meeting with POA and family on or before POC due date.
	8 9 10 11 12 13 14	Based on Dual POA does not restrict visitor or calls from family. Which poses a potential health and safety risk for persons 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: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

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