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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601574
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:15:14 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
02/09/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20230209143832
FACILITY NAME:CARTAGENA HOMEFACILITY NUMBER:
198601574
ADMINISTRATOR:PEARL LAMBFACILITY TYPE:
735
ADDRESS:1306 CARTAGENA STREETTELEPHONE:
(562) 988-8142
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:4CENSUS: 4DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:ADMINISTRATOR PEARL LAMBTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff do not follow COVID-19 protocol
Facility bathroom faucet does not deliver hot water
Licensee does not store toxins locked and inaccessible to residents in care
Facility bathroom floor is not equipped with non-slip mat
Facility shower is not equipped with privacy curtain
Licensee does not maintain emergency lighting in facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Cartagena Home facility on 02/16/2023 at around 08:45 AM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10-day visit on 02/16/2023 around 08:45 AM. LPA Calderon initiated an investigation for the above-mentioned allegations and conducted a face-to-face interview with Administrator (S1). On 02/08/2023 LPA Calderon could not interviewed W1 for complaint as W1 was anonymous. On 02/16/2023 LPA Calderon requested copies of the following: Staff and Resident rosters, Covid 19 vaccine cards for staff and residents. Covid 19 testing for staff and residents. On 02/16/2023 LPA Calderon and S1 toured the facility to include all common areas and 3 bathrooms and kitchen area. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint.
The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
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 4
Control Number 11-AS-20230209143832
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 02/16/2023
NARRATIVE
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Regarding Allegation #3: Licensee does not store toxins locked and inaccessible to residents in care.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that they follow all rules for locking up chemicals and making them inaccessible to all residents and guests. S1-S4 state that they clean the facility and make sure that they lock up prior to moving forward. S1-S4 state that training is given monthly to make sure the rule is not forgotten. On 02/16/2023 LPA Calderon toured the facility with S1. LPA Calderon noted and checked where the chemicals are stored. LPA Calderon noted that knifes and chemicals were locked up under the kitchen sink and locked up near the washer and dryer area. LPA Calderon also noted some chemicals are stored in the garage area, but only staff has access to this area.

Regarding Allegation #4: Facility bathroom floor is not equipped with non-slip mat.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that all 3 bathrooms have a non-skid mat, but some residents use a chair to shower, and the mat is not needed. On 02/16/2023 LPA Calderon toured the facility with S1. LPA Calderon noted non-skid mats in all 3 bathrooms. LPA Calderon also noted shower chairs in bathroom showers 1 and 2. LPA Calderon noted that non-slip mats may not be needed.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230209143832
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 02/16/2023
NARRATIVE
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Regarding Allegation #1: Staff do not follow Covid 19 protocols.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that all staff follow Covid 19 rules and regulations. S1-S4 state that fellow staff refused to work due to positive covid residents. On 02/16/2023 LPA Calderon toured the facility with S1. LPA Calderon noted covid 19 sign in sheet on front door, LPA Calderon noted that all persons had to have temperature taken and answer covid questions prior to entering the facility. LPA Calderon noted staff cleaning common touched areas and noted residents isolate in their rooms except R2 who refused to stay in R2 room and watched TV and was watched by staff. On 02/16/2023 LPA Calderon reviewed covid 19 testing and vaccine cards for all staff and residents.

Regarding Allegation #2: Facility bathroom faucet does not deliver hot water.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon toured the facility with S1. LPA Calderon checked hot water temperature for facility 3 bathrooms and kitchen area. LPA Calderon noted the average water temperature is 108 degrees. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that there is no issues or concerns regarding hot water in the facility

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20230209143832
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 02/16/2023
NARRATIVE
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Regarding Allegation #5: Facility shower is not equipped with privacy curtain.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. S1-S4 state that all 3-bathroom showers have a privacy curtain but that R1 is aggressive while taking a shower and pulls the curtain down. S1-S4 state that staff closes the bathroom door for all residents’ showers and provide privacy on top of the shower curtain gives. S1-S4 state that staff would never shower a resident in front of another resident due to privacy issues. On 02/16/2023 LPA Calderon toured the facility with S1 for complaint. LPA Calderon noted bathroom 1 did not have a curtain, but the door was closed for privacy. LPA Calderon noted shower curtains in bathroom 2 and 3.

Regarding Allegation #6: Licensee does not maintain emergency lighting in facility.

On 02/08/2023 LPA Calderon attempted to interview W1 for complaint. W1 was anonymous and no interview could be done. On 02/16/2023 LPA Calderon attempted to interview R1-R4 for complaint. No interview could be done as R1-R4 have mental health issues and could not answer any questions regarding the complaint. On 02/16/2023 LPA Calderon interviewed S1-S4 for complaint. LPA Calderon noted possible typo in allegation vs LIC802 summary which state “food supplies”. S1-S4 state there are no lighting issues, and that staff are given light bulb replacement when needed. S1-S4 state that emergency food supply 2 day and 7 days are maintained, and that staff buys enough food to feed residents and staff. On 02/16/2023 LPA Calderon toured the facility with S1. LPA Calderon checked the food supply in the kitchen, checked the refrigerator for perishable foods and non-perishable foods and noted that food supply is sufficient for 4 residents and staff. LPA Calderon also noted extra food supply and water supply found in the garage.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff do not follow covid 19 protocols” “facility bathroom faucet does not deliver hot water” “licensee does not store toxins locked and inaccessible to residents in care” “facility bathroom floor is not equipped with non-slip mat” “facility shower is not equipped with privacy curtain” “licensee does not maintain emergency lighting in facility” is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator (S1).

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4