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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320398
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:01:20 PM

Substantiated


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
08/16/2024 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240816112443
FACILITY NAME:PENINSULA POINTE BY COGIRFACILITY NUMBER:
198320398
ADMINISTRATOR:KITAGAWA, DESIREEFACILITY TYPE:
740
ADDRESS:27520 HAWTHORNE BOULEVARDTELEPHONE:
(310) 697-6236
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY:121CENSUS: 20DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Executive Desiree KitagawaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff are exposing residents to a contagious illness.
INVESTIGATION FINDINGS:
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On 08/21/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation. LPA Cloyd spoke with Executive Director Desiree Kitagawa and explained the purpose of the visit.

The investigation consisted of the following: During today’s investigation, LPA Cloyd reviewed facility records and interviewed three residents and eight staff members.

Continue to LIC9099-C.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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 3
Control Number 11-AS-20240816112443
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: PENINSULA POINTE BY COGIR
FACILITY NUMBER: 198320398
VISIT DATE: 08/21/2024
NARRATIVE
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Allegation(s):
Staff are exposing residents to a contagious illness.

The investigation revealed the following: Regarding the allegation "Staff are exposing residents to a contagious illness,” it is being alleged that the Licensee allowed two staff members who tested positive for COVID-19 continue to work while wearing cloth masks. Record review reveals that the facility was not following the most recent (04/22/2024) Los Angeles County Department of Public Health (LAC DPH) COVID-19 and Common Respiratory Viruses Guidance for Community Congregate Settings. It states, for non-healthcare staff “who test positive for… COVID-19 must go home immediately if onsite and must be excluded from the workplace for five days after symptoms began or after testing positive if no symptoms. Isolation may end and staff may return to work after Day 5 if all the following criteria are met…”. Record review revealed that two staff members worked within five days of testing positive. Six (6) out of eight (8) staff interviews, including the Executive Director, indicated that staff was allowed to return to work within five days of testing positive for COVID-19.



Regarding the allegation “Staff are exposing residents to a contagious illness,” based on record review and interviews, the preponderance of evidence has been met therefore the allegation is Substantiated.

Deficiencies were issued. An exit interview was conducted and plans of correction developed. A copy of this report, LAC DPH Guidance provided, and appeals rights was reviewed and left with the Executive Director Desiree Kitagawa.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240816112443
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: PENINSULA POINTE BY COGIR
FACILITY NUMBER: 198320398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations...

This requirement is not met as evidenced by:
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The Administrator will review Los Angeles County Department of Public Health (LAC DPH) COVID-19 and Common Respiratory Viruses Guidance for Community Congregate Settings (04/22/2024) and implement its guidance for non-healthcare staff with positive COVID-19 diagnosis to the facility's
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Based on record review and interviews, the licensee did not comply with the section cited above for two staff members which poses an immediate health risk to persons in care. LPA Cloyd observed that Staff #2 & #3 worked within five days after testing positive for COVID-19 which is against LAC DPH guidelines.
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procedures and email it to regina.cloyd@dss.ca.gov by the POC due date. The Administrator will continue to review updated Provider Information Notices (PINs) and implement the strictest guidance COVID-19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
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