198320131-1-9-2023-11-AS-SCIS-CR9QF6-20230426120723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320131
Report Date: 01/09/2023
Date Signed: 01/09/2023 04:05:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/15/2022 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220815104213

FACILITY NAME:	SEASONS MEMORY CARE AT ROLLING HILLS		FACILITY NUMBER:	198320131
ADMINISTRATOR:	THORNTON, TIERRE		FACILITY TYPE:	740
ADDRESS:	2455 PACIFIC COAST HWY		TELEPHONE:	(424) 488-0593
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	68	CENSUS: 29	DATE:	01/09/2023
		UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Olivia Blaylock		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff hit client

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify findings, it does not supersede the complaint investigation findings reflected on report created on 8-19-2022

On or about 8/19/2022 9:40 a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced complaint visit, regarding the allegation above at Seasons Memory Care. LPA was met by facility Administrator Tierre Thornton (S1) the purpose of the visit was explained.

Investigation Consisted of the following:
Resident Interviews (R1- R6), Staff Interviews (S1-S7), Observation of Physical Plant and R1’s room, Record Review, and copies obtained of Pertinent documents pertaining to the allegation. LPA requested from the facility (Admissions Agreement, House Rules, Physicians Report /Medical Records, Client Roster, Staff Roster) Needs and Services, Functional Capability Assessment, SIR’s/SOC 341, staff / nursing notes and Police Reports if any. Resident(s) file(s) for Resident 1(victim) inclusive of all documents requested herein.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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-20220815104213

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SEASONS MEMORY CARE AT ROLLING HILLS	FACILITY NUMBER: 198320131
	VISIT DATE: 01/09/2023

NARRATIVE

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Investigation Revealed the following.

Regarding Allegation: Staff hit client.

On 8/19/2022 LPA Randle interviewed Administrator Tierre Thornton (SI) she provided statements that she is unaware of any physical hitting or altercations between any residents and staff inclusive of (R1) subject of the complaint. LPA interviewed S1- S7 all stated they had not witnessed any physical hitting or altercations between any residents and staff inclusive of resident (R1) nor had any residents reported being hit or abused by staff to any staff member or administrator. LPA interviewed R1, R1 confirmed the allegation however stated she could not identify who hit her by seeing in-person or by photograph when asked by LPA. LPA attempted to interview other residents (2-6) however do to residents medical issues (Dementia) LPA was not able to gather comprehensible information regarding allegation.

LPA concluded interviews with resident and staff and reviewed records. Based on interviews and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED.

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 unsubstantiated

Exit interview held. A copy of the report was provided to Administrator Olivia Blaylock

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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