198320119-3-4-2024-11-AS-MVAO-D3BTYM-20240313150859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320119
Report Date: 02/14/2024
Date Signed: 03/04/2024 02:51:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
07/26/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230726080640

FACILITY NAME:	MONTOAK SENIOR LIVING INC.		FACILITY NUMBER:	198320119
ADMINISTRATOR:	SHAHEEN, NAJMA		FACILITY TYPE:	740
ADDRESS:	1700 248TH STREET		TELEPHONE:	(310) 406-6193
CITY:	LOMITA	STATE: CA	ZIP CODE:	90717
CAPACITY:	12	CENSUS: 12	DATE:	02/14/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Najma Shaheen		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff mismanaged resident's medication
Staff failed to meet resident's needs
Resident was financially abused while in care
Staff failed to provide adequate transportation for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, February 14, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Licensee/Administrator Najma Shaheen. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the investigation. LPA Bunker interviewed staff 1-2 (S1-S2) and residents 2-6 (R2-R6). R1 is no longer residing at the facility. LPA Bunker asked questions relevant to the nature of the complaint. We observed and reviewed resident records, medications, MARs, and documents for accuracy. LPA Bunker requested copies of supporting documents. Administrator Najma Shaheen provided LPA Bunker with copies.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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 4

Control Number 11-AS-20230726080640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MONTOAK SENIOR LIVING INC.	FACILITY NUMBER: 198320119
	VISIT DATE: 02/14/2024

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Staff mismanaged resident's medication.
Upon investigation, both staff members (S1-S2) and residents (R2-R6) have reported comprehensive adherence to medication management protocols. It is asserted that all medications are dispensed strictly in accordance with physician orders. Furthermore, S1-S2 has confirmed that Resident 1 (R1) received her medication as prescribed. The facility ensures all medications are appropriately labeled, and securely stored in a locked cabinet within the office area, thus inaccessible to residents without proper authorization. Notably, there is no documentation from a physician suggesting R1 is authorized to self-manage her medication. Based on these observations, both staff and residents (S1-S2 and R2-R6) refute the allegation of medication mismanagement.

Allegation #2: Staff failed to meet resident's needs.
Regarding Allegation #2, which posits that staff failed to meet the resident's needs, a thorough investigation has been conducted. According to statements from staff members S1-S2 and residents R2-R6, it has been consistently reported that the resident's daily care needs are being met satisfactorily. These parties have confirmed that the staff is providing adequate care and supervision, highlighting the staff's competence and specialized training to fulfill the necessary services for residents. Furthermore, it was mentioned that staff members undergo ongoing training to maintain high standards of care.

It has been noted by S1 that prior to the resident's admission to the facility, the individual was briefly in hospice care. The decision to discontinue hospice services was made by the hospice provider, indicating that the resident no longer required such care. It was also observed that the resident, who has access to a walker, is capable of ambulation without it and was not dependent on oxygen gas, despite being a heavy smoker. This detail is pertinent as, typically, hospice care provides oxygen support when necessary, which would be retracted once a resident exits hospice care.

S1 has emphasized that the resident's needs and the services provided are clearly outlined in their admission agreement. The staff's adherence to Title 22 Regulations, along with facility policies and procedures, ensures that care standards are consistently met.

See continued LIC9099-C page 3

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20230726080640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MONTOAK SENIOR LIVING INC.	FACILITY NUMBER: 198320119
	VISIT DATE: 02/14/2024

NARRATIVE

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Continued LIC9099-C page 3

Based on the evidence and statements provided, S1-S2 and R2-R6 have collectively refuted Allegation #2, asserting that the staff has not failed to meet the resident's needs.

Allegation #3: Resident was financially abused while in care.
In response to this, allegation interviews were conducted with both staff members (S1-S2) and residents 2-6 (R2-R6). The collective feedback from these interviews unanimously indicated residents are not financially abused while in care. S1-S2 and R2-R6 stated residents handle their owed debit cards and funds and staff do not handle resident's debit cards. S1-S2 stated staff did not make any online purchases from a resident's debit card. (R2-R6) expressed their satisfaction with living at the facility, highlighting the respect, dignity, and quality of care they receive. They also commended the facility for providing a secure, healthful, and comfortable living environment and they were happy. S1-S2 refuted the allegation, reinforcing the commitment to safety and well-being upheld at the facility.

Allegation #4: Staff failed to provide adequate transportation for residents.
In response to concerns about transportation, it has been clarified by S1-S2 and R2-R6 that the facility offers complimentary transportation services for residents requiring assistance. Access to transportation encompasses family support and arrangements made by the Licensee/Administrator to ensure residents' mobility needs are addressed. S1 has taken responsibility for escorting R1 to medical appointments, shopping, and other activities. This concerted effort by staff and the administration to provide comprehensive transportation solutions is affirmed by S1-S2 and R2-R6, thereby refuting the allegation of inadequate transportation provision.

Investigation revealed the following:
Interviews conducted with staff members S1-S2 and residents R2-R6 have consistently demonstrated that there is no mismanagement of residents' medication by the staff. It has been affirmed across the board that the daily needs of the residents are being adequately met by the staff. S1-S2 and R2-R6 stated that there have been no instances of financial abuse of any residents by the staff members or another resident.

See continued LIC9099-C page 4

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230726080640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: MONTOAK SENIOR LIVING INC.	FACILITY NUMBER: 198320119
	VISIT DATE: 02/14/2024

NARRATIVE

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Continued LIC9099-C page 4

In terms of transportation, it was highlighted that the facility provides complimentary transportation services to residents in need. This ensures that all residents have access to necessary external appointments or engagements, irrespective of their personal transportation arrangements. Residents R2-R6 confirmed their access to this service, noting that family members and representatives also contribute to their transportation needs when required.

During the comprehensive interviews with both staff members S1-S2 and residents R2-R6, all allegations regarding medication mismanagement, neglect of residents' daily needs, financial abuse, and inadequate transportation services have been categorically denied.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Licensee/Administrator Najma Shaheen.

There were no deficiencies cited. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

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