198600145-9-30-2021-28-AS-WSHO-C9Q2BD-20211214161458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600145
Report Date: 09/29/2021
Date Signed: 09/30/2021 07:58:10 AM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2021 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210909143401

FACILITY NAME:	BELL GARDENS MANOR		FACILITY NUMBER:	198600145
ADMINISTRATOR:	MARIA ZUNIGA		FACILITY TYPE:	735
ADDRESS:	8424 S EASTERN		TELEPHONE:	(562) 927-1389
CITY:	BELL GARDENS	STATE: CA	ZIP CODE:	90201
CAPACITY:	141	CENSUS: 88	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maria Zuniga		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained injuries while in care
Resident allowed to leave the facility unassisted
Staff does not provide adequate supervision to resident in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Zuniga and explained the reason for the visit.
The purpose of the visit is a subsequent visit to investigate the above allegations.
At today's visit 9/29/2021 from 9 A.M to 10.00 A.M. Client's C1-C 6 were interviewed.
At 10;15 A.M. to 10:45 AM Staff S1 and S 2 were interviewed.
In regards to the allegation Resident sustained injuries while in care, based on interviews conducted and information gathered staff interviewed stated that Cleint 1 was observed walking into the facility and then getting into line for snacks and then telling staff he had fallen and hurt his arm. Staff acted promptly calling 911 immediately. Staff stated that Client 1 would leave the facility frequently to panhandle at the liquor store and bakery.
Client 1 was able to leave the facility unassisted as noted on Physician's Report dated 02/05/2014.
It should be noted that Home Health tended to Client 1 2x a week.
Client's interviewed stated that staff acted promptly on falls by Client 1 and provided good care and

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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 28-AS-20210909143401

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BELL GARDENS MANOR	FACILITY NUMBER: 198600145
	VISIT DATE: 09/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

supervision.
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.

In regards to the allegation Resident allowed to leave the facility unassisted based on interviews conducted and information gathered clients who knew Client 1 stated that he would go to stores in the community daily for soda, donuts and cigarettes and often would panhandle in the community.
Client 1 was able to leave the facility unassisted as noted on Physician's Report dated 02/05/2014.
Staff interviewed stated that Client 1 would leave to panhandle in the community and go to the area stores.
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.

In regards to the allegation Staff does not provide adequate supervision to resident in care, based on interviews conducted and information gathered client's interviewed stated that staff do provide good care and supervision and that staff have acted promptly when client's have had seizures, falls and preventing confrontations.
Stated that staff had provided Client 1 with new shoes when his were ripped and staff take good care of him.
Client's stated that staff help with all meals and medication.
Staff interviewed stated that they had helped promptly to assist Client 1 with falls and promptly got medical help.
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.
Client 1 no longer resides at the facility as of 9/13/2021.

Exit interview conducted and report to be e-mailed.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2