198601748-8-15-2022-11-AS-MVAO-CK4SRK-20221011140627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601748
Report Date: 08/11/2022
Date Signed: 08/15/2022 04:27:18 PM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220725083145

FACILITY NAME:	DIAMOND STAR ASSISTED LIVING		FACILITY NUMBER:	198601748
ADMINISTRATOR:	MARIA TERESA MATIAS		FACILITY TYPE:	740
ADDRESS:	2038 W. 233RD STREET		TELEPHONE:	(424) 328-0468
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 6	DATE:	08/11/2022
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	MARIA TERESA MATIAS		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident is not provided a comfortable temperature.
Staff threatens resident in care.

INVESTIGATION FINDINGS:

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On 8/11/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit at this facility. Upon arrival, LPA called the facility to conduct a risk assessment. LPA spoke with Administrator Maria Matias who confirmed the facility is Covid-19 free. LPA met with House Manager (HM) Norma Graneta shortly after and explained the purpose of today's visit. Administrator Maria Matias arrived later and joined the visit.

The investigation consisted of the following: LPA Montoya interviewed the Administrator (S1), House Manager (S2), Caregiver (S3), two residents (R1 and R2), two witnesses (W1 and W2). LPA attempted to interview four residents (R3-R6). LPA was unable to interview R3 and R6 due to their medical conditions, R4 refused to talk and R5 was sleeping during the visit. LPA requested and obtained additional home health records of R1 from the administrator.

Investigation report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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-20220725083145

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DIAMOND STAR ASSISTED LIVING	FACILITY NUMBER: 198601748
	VISIT DATE: 08/11/2022

NARRATIVE

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INVESTIGATIONS REVEALED:

Allegation: Resident is not provided a comfortable temperature.

It is alleged Resident is not provided a comfortable temperature. The Reporting Party (RP) stated the alleged perpetrator doesn't provide Resident #1 (R1) with air conditions during the high temperature. Based on the department's interviews with Residents (R1 and R2), they are provided with a comfortable temperature inside the facility. Staff (S1-S3) stated they are comfortable with the temperature in the facility. Interviews with two witnesses (W1 and W2) revealed they wish the facility will provide an air conditioner in the resident bedrooms for their use during high temperature. Based on LPA's observations during complaint visits on 7/26/22 and 8/11/22 , the facility has comfortable temperature. Based on observations and interviews, there is no sufficient evidence to corroborate the allegation above.

Allegation: Staff threatens resident in care.

It is alleged staff threatens resident in care. Based on the department's interviews with Residents (R1 and R2), they have not been threatened by any staff. Staff (S1-S3) and witness (W1) stated they have not observed any staff threatened a resident. Interview with a witness (W2) revealed W2 heard and observed a staff who manages the facility is not sympathetic, not empathetic, blunt, aggressive and assertive. W2 wishes the staff treats the residents better. However, W2 does not believe staff has threatened any resident.
Based on observations and interviews, there is no sufficient evidence to corroborate the allegation above.

Based on interviews, observation and interviews conducted, the Department did not find sufficient evidence to support allegations: " Resident is not provided a comfortable temperature", and "Staff threatens resident in care".

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.

Exit interview conducted and a hard copy of this report was provided to Administrator Maria Teresa Matias.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC9099 (FAS) - (06/04)

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