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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320131
Report Date: 03/02/2022
Date Signed: 03/02/2022 07:41:39 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
02/28/2022 and conducted by Evaluator Don Senaha
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220228112527
FACILITY NAME:SEASONS MEMORY CARE AT ROLLING HILLSFACILITY NUMBER:
198320131
ADMINISTRATOR:THORNTON, TIERREFACILITY TYPE:
740
ADDRESS:2455 PACIFIC COAST HWYTELEPHONE:
(424) 488-0593
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:68CENSUS: 22DATE:
03/02/2022
UNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Tierre Thorton - Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are administering resident with injections.
INVESTIGATION FINDINGS:
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On 03/02/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Executive Director Tierre Thorton.

The investigation consisted of the following: LPA requested resident roster, staff roster and other service documents on 03/02/2022. LPA conducted interviews with residents (R1-R10) and staff (S1-S5). Resident (R1-R7, R10) were unavailable to interview at the time. A plant inspection of the facility was conducted 03/02/2022.

Investigation revealed:

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
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 2
Control Number 11-AS-20220228112527
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: SEASONS MEMORY CARE AT ROLLING HILLS
FACILITY NUMBER: 198320131
VISIT DATE: 03/02/2022
NARRATIVE
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Allegation: Staff are administering resident with injections.

It is alleged that staff are administering resident with injections. Resident (R8-R9) stated they have never witnessed staff using a needed to administer medications. Staff (S1-S5) stated they do not use needles to administer medications. Staff (S1) stated last week resident (R1) was given medication through a syringe. Staff (S1-S2) stated the hospice orders the PRN medication through their pharmacy and has it delivered to the facility. Staff (S1-S2) stated the PRN medication is given to resident (R1) as needed. Staff (S1-S2) stated the syringe used for administering medication is to measure the amount of medication properly and is pre-package from the pharmacy through the hospice order. Staff (S1-S2) stated the syringe is not a needle but used to administer sub-lingually to resident (R1) to ensure the proper dose of medication.

Based on LPA’s interviews conducted, record reviews and observation, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

An exit interview was conducted with Executive Director Tierre Thorton and a hard copy was provided.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2