198601570-4-24-2024-11-AS-RORN-D4NL69-20240425082818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601570
Report Date: 03/06/2024
Date Signed: 04/24/2024 01:52:06 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2024 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240305082401

FACILITY NAME:	SENIOR LIVING LIFESTYLE- PALOS VERDES		FACILITY NUMBER:	198601570
ADMINISTRATOR:	ROBERT SMITH		FACILITY TYPE:	740
ADDRESS:	3832 PALOS VERDES DRIVE NORTH		TELEPHONE:	(424) 241-2539
CITY:	PALOS VERDES ESTATES	STATE: CA	ZIP CODE:	90274
CAPACITY:	6	CENSUS: 4	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Robert Smith/Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff does not accord resident privacy.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024.

LPA’s Darneisha Cross and Alfonso Iniguez conducted an unannounced complaint visit. LPAs Iniguez met with Robert Smith /Administrator. LPAs explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Resident’s interviews (R#1-R#4) and Reporting Party Interview (RP) and witnesses interviews (W#1-W#4). LPA obtained and reviewed the following documents: Personnel Roster, Staff Roster, (R#1-R#4) Identification and Emergency Information, (R#1-R#4), (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#4) Needs and Services Plan, (R#1-R#4).

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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-20240305082401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SENIOR LIVING LIFESTYLE- PALOS VERDES	FACILITY NUMBER: 198601570
	VISIT DATE: 03/06/2024

NARRATIVE

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024.

Investigation Revealed the Following:

Allegation: Staff does not accord resident privacy.

The details of the complaint alleged that facility staff does not accord resident’s privacy.

During the records review, LPA Iniguez and Cross reviewed the following documents: (R#1-R#4) Admissions Agreement, in which The Right to Privacy in Accommodations clause was written. The clause states that “the statutory and regulatory resident and personal rights agreement included with the agreement to allow residents a “reasonable level of privacy in accommodations” as outlined in health and safety.” LPAs observed the resident or legal representative signs this clause. In addition, LPAs observed the Resident/Personal Rights clause, in the clause it is stated that “The resident and the resident’s representative, if any, is entitled under California State law to receive a copy of the resident’s rights pertaining to admission and retention in this facility.” LPAs observed that the resident or legal representative signs this clause.

During the facility tour, LPA Iniguez observed the residents’ rights posted in a prominent area where residents, family, and visitors can access them.

During an interview with the Administrator (A#1), he stated that he is aware of the residents’ rights and that the residents in care are getting their private conversations respected by facility staff. In addition, (A#1) stated that he only stays with the residents if they ask me to stay when they do not know the person asking them questions. Also, (A#1) stated that he has always respected residents’ private conversations. Moreover, (A#1) stated that he had observed instances where the Long-term Care Ombudsman-LTCO does not follow the house rules while visiting the residents. Specifically, they knock on the door and do not wait for (A#1) to sign them in, instead they directly enter the residents' rooms. In such situations, (A#1) asks the residents if they would prefer to speak to the LTCO alone or if they would like (A#1) to be present during the conversation. (A#1) respects their choice and stays accordingly. Also, (A#1) stated that when residents in care received visits or phone calls, he respects their privacy.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240305082401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SENIOR LIVING LIFESTYLE- PALOS VERDES	FACILITY NUMBER: 198601570
	VISIT DATE: 03/06/2024

NARRATIVE

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024.

During interviews with residents (R#1-R#4), (4) out of (4) stated that they are aware of their rights, and (4) out of (4) stated that they feel facility staff respect their rights. In addition, (3) out of (4) state that no facility staff has ever not respected their private conversations. When LPA Cross interviewed (R#2), LPA observed (R#2) watching TV and eating breakfast; LPA Cross noticed (R#2) needed to be more engaging in the questions LPA was asking them. Moreover, (4) out of (4) residents stated that when the Long-term Care Ombudsman comes to the facility to see them, they have private conversation with them, and the facility administrator is not present during these conversations. Also (4) out of (4) stated that when they received telephone calls or visits from friends and family members, the facility administrator gives them privacy.

During a phone interview with witnesses (W#1-W#4), (4) out of (4) stated that the facility values and respects residents' privacy. Visitors can enjoy the peace of mind that they can confidently talk to their loved ones without any interference from the administrator.

During this investigation, LPAs did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of the Complaint Report was given to Robert Smith /Administrator.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

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