198320054-2-2-2024-11-AS-EMAZ-D2N22Z-20240220160134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320054
Report Date: 02/02/2024
Date Signed: 02/02/2024 10:09:04 AM

Unsubstantiated

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
06/22/2022 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20220622121544

FACILITY NAME:	LOMITA TERRACE GUEST HOME		FACILITY NUMBER:	198320054
ADMINISTRATOR:	T.BUCA, JERISSA MARIE		FACILITY TYPE:	740
ADDRESS:	1711 W 243RD ST		TELEPHONE:	(408) 916-7347
CITY:	LOMITA	STATE: CA	ZIP CODE:	90717
CAPACITY:	0	CENSUS: 0	DATE:	02/02/2024
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Robin Taporco/Licensee		TIME COMPLETED:	10:08 AM

ALLEGATION(S):

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Staff hit resident
Resident sustained injuries in care
Staff are mismanagaing resident's medication
Staff are not feeding resident
Resident loss a significant amount of weight
Staff refused to call 911
Resident was denied visitors
Continue on LIC 812....

INVESTIGATION FINDINGS:

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On 2/2/24, Licensing Program Analyst-LPA Alfonso Iniguez conducted a subsequent complaint visit at facility Torrance Regency Senior Living #198603092 to deliver the complaint investigation findings for closed facility Lomita Terrace Guest Home #198320054. LPA met with the Licensee/Robin Taporco, who assisted with the visit. The purpose of the visit was explained. On 10/14/2023, LPA Alfonso Iniguez conducted a records review of a 10-day complaint assigned on 6/2/22 to former LPA Don Senaja. This investigation is based on the interviews and documentation gathered by LPA Senaja.

Investigation Consisted of: On 6/28/2022, Licensing Program Analyst-LPA Don Senaja initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Jerissa Bucu.

Continue on LIC 812...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff hit resident.

The details of the complaint alleged that the facility staff hit a resident while in care.

During an Interview with Administrator (A#1), she stated that she has not witnessed a staff hitting a resident at the facility. Also, (A#1) stated that no staff/resident/family have ever reported to her that a resident has been hit by a staff.

During an interview with the house manager (S#1), she stated that she has never hit a resident at the facility, and no staff member or resident/family member has ever reported that a resident has been hot by a staff.

During interviews with residents (R#1-R#4), 4 out of 4 stated that no staff member has ever hit them. In addition, 4 out of 4 indicated that they felt they were given a comfortable environment while living at the facility.
During an Interview with Witness (W#1), they stated that their mother has never been hit by a staff member while living at the facility.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Resident sustained injuries in care.

The details of the complaint alleged that the resident sustained injuries while in care.

During the records review, LPA observed the facility’s training in-services regarding Dementia Training dated 3/1/21,3/10/21, 3/16/21, 3/20/21, 3/30/21, 4/12/22, 4/20/22. On these training courses, facility staff are trained to care for people with dementia. In addition, LPA reviewed the Personnel Report or LIC 500 and observed that staff were available in the morning, afternoon, and night.

During an Interview with Administrator (A#1), she stated that (R#1) had a bruise on their face due to a fall. Also, (A#1) stated that (R#1) had behavioral issues. LPA confirmed medical condition on the LIC 602.

During interviews with House Manager (S#1), she stated that (R#1) had some injuries due to their medical condition.

During interviews with residents (R#1-R#4), 4 out of 4 stated that they have not had any unexplained bruises on their arms or faces.

During an Interview with Witness (W#1), she stated that (R#1) had not had any unexplained bruises while living in the facility.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Staff are mismanaging residents’ medication.

The details of the complaint alleged that the facility staff were mismanaging the resident’s medication.

During the Records Review, LPA Iniguez observed (R#1-R#4) Medication Administration Records (MARS) from March to June 2022; LPA did not observe any discrepancies.

During an Interview with the Administrator (A#1), she stated that the people in charge of the medication are the caregivers. Also, (A#1) stated that she did not know if the staff ever mismanaged the resident’s medications. In addition, (A#1) noted that the protocol when a resident refuses medication is to not force it on them and report it to the family, hospice agency, and physician.

During interviews with the House Manager(S#1), she stated that she is one of the people who gives the medications to the residents. Also, she noted that no staff has ever mismanaged the resident’s medications, and the protocol when a resident refuses to take their medications is to go back and try again; if they are still refusing, we tell the manager and document on the MAR.

During interviews with residents (R#1-R#4), 4 out of 4 stated that they take their medications, and the caregiver gave the medicines to them.

During an Interview with witness #1(W#1), she stated that the staff gave medications to (R#1).

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Staff are not feeding residents.

The details of the complaint alleged that the facility staff are not feeding residents in care.

During the Records Review, LPA Iniguez observed (R#1-R#4) Admissions Agreement; it is stated that Food Services are included as follows: Three (3) nutritious meals per day and between-meal snacks and Special diets if a physician prescribed. Also, LPA observed a picture of a sample weekly menu posted at the facility.

During an Interview with the Administrator (A#1), she stated that residents living at the facility are given a comfortable living environment, a clean house, their bed, prepared meals, and snacks. Also, (A#1) stated that the facility menu is posted in the refrigerator, and residents are given (3) meals daily plus snacks. In addition, (A#1) stated that Breakfast is served at 8:00 AM, Lunch is served at 11:30 AM, and Dinner is served at 4:30 PM. Moreover, (A#1) stated that if a resident refuses to eat what the facility is serving, they will encourage the resident to eat, but if they still refuse, they will inform their families.

During interviews with staff (S#1), she stated that the facility menu is posted in the refrigerator, and residents are given (3) meals daily plus snacks. In addition, (S#1) stated that Breakfast is served at 8:00 AM, Lunch is served at 11:30 AM, and Dinner is served at 4:30 PM. Moreover, (S#1) stated that if a resident refuses to eat what the facility is serving, they will encourage the resident but not force them.

During interviews with residents (R#1-R#4), 4 out of 4 stated that they get (3) meals per day plus snacks between meals.

During an Interview with witness #1 (W#1), she stated that the facility gives (R#1) breakfast, lunch, Dinner, and snacks.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Resident lost a significant amount of weight.

The details of the complaint alleged that the resident lost a significant amount of weight while in care.

During an Interview with the Administrator (A#1), she stated that no resident has had significant weight loss recently.
During interviews with staff (S#1), she stated that no resident has had significant weight loss recently.

During interviews with witness #1 (W#1), she stated that (R#1) did not lose weigh significantly.

Allegation: Staff refused to call 911.

The details of the complaint alleged that the facility staff refused to call 911 for a resident.

During an Interview with Administrator (A#1), she stated that there have been no 911 calls recently for the facility from anybody here. Also, (A#1) noted that staff has yet to be told to not call 911 by me or a family member of the residents.
During interviews with staff (S#1), she stated that there have been no 911 calls recently for the facility from anybody here. Also, (S#1) noted that staff has yet to be told to call 911 by me or a family member of the residents.
During interviews with residents (R#1-R#4), 4 out of 4 stated that they have not gone to the hospital for any reason recently.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Resident was denied visitors.

The details of the complaint alleged that the facility denied the entry of a visitor for a resident.

During an Interview with Administrator (A#1), she stated that she has not ever denied any family member to visit their loved one at the facility.

During interviews with staff (S#1), she stated that she has never denied any family member visiting their loved one at the facility.

During interviews with residents (R#1-R#4), 4 out of 4 stated that a family member was the last person to visit them.

Allegation: Staff made inappropriate comments towards the residents.

The details of the complaint alleged that the facility staff made inappropriate comments towards a resident.

During an Interview with Administrator (A#1), she stated that she had not seen or heard a staff member make inappropriate comments towards any resident. Also, she stated that no one has ever reported to her that a staff member made an inappropriate comment towards any resident.

During interviews with staff (S#1), she stated that she or other staff have never made inappropriate comments toward any resident.

During interviews with residents (R#1-R#4), 4 out of 4 stated that no one has ever made inappropriate comments toward them.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 7 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Staff denied residents a TV.

The details of the complaint alleged that the facility staff did not allow a resident to watch TV.

During an Interview with the Administrator (A#1), she stated that no staff has ever not let a resident’s family bring in personal belongings like a lamp, bed, TV, or chair in their room.

During interviews with staff (S#1), they stated that no staff has ever not let a resident’s family bring in personal belongings like a lamp, bed, TV, or chair in their room.

During interviews with residents (R#1-R#4), 4 out of 4 stated that no facility staff ever denied them or their family bring personal belongings like a TV, lamp, or chair.

During an interview with witness #1 (W#1), they stated that they have never experienced facility staff not letting them bring personal belongings (R#1).

Allegation: Staff are not meeting residents’ toileting needs.

The details of the complaint alleged that the facility staff did not help residents with their hygiene needs.

During an Interview with the Administrator (A#1), she stated that facility staff assist residents with ADLs.

During interviews with staff (S#1), she stated they assist residents with ADLs.

During interviews with residents (R#1-R#4), 4 out of 4 stated that they are getting assistance with their ADLs, like showering, bathing, and going to the restroom.

During an interview with witness #1 (W#1), they stated that facility staff are assisting (R#1) with their ADLs.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

Page: 8 of 9

Control Number 11-AS-20220622121544

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: LOMITA TERRACE GUEST HOME	FACILITY NUMBER: 198320054
	VISIT DATE: 02/02/2024

NARRATIVE

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Allegation: Staff did not safeguard residents’ personal belongings

The details of the complaint alleged that the facility failed to safeguard residents’ personal belongings.

During an Interview with Administrator (A#1), she stated that a family member reported missing socks and briefs last year.

During interviews with staff (S#1), she stated that last year, a family member reported some socks and briefs missing.

During interviews with residents (R#1-R#4), 4 out of 4 stated that no personal belongings were ever missing or taken from the facility.

During an interview with witness #1 (W#1), they stated that (R#1) has no valuable items at the facility.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED.

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.

California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Robin Taporco/Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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