198601838-12-14-2022-28-AS-RORN-CR9VLK-20230426163204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:44:42 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 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
12/08/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221208153132

FACILITY NAME:	DOWNEY RETIREMENT CENTER		FACILITY NUMBER:	198601838
ADMINISTRATOR:	MICHELE R GOODNEY		FACILITY TYPE:	740
ADDRESS:	11500 DOLAN AVENUE		TELEPHONE:	(562) 869-2416
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	252	CENSUS: 100	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Michele Goodney		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff are not addressing resident's medical condition.
Facility staff do not answer resident's call button at night.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to facility for the purpose of investigating the allegations above. LPA met with Administrator Michele R Goodney and explained the purpose of the visit.
LPA conducted interviews from 10:00 AM to 11:15 AM with residents 1-8 (R1 -R8) Administrator and 1 facility staff S1. LPA obtained and reviewed staff and resident rosters.
Documentation from PIH hospital for R1 was reviewed.
LPA along with Assistant Administrator S2 toured the following Rooms at 11:15 AM:
102, 118,125, 201, 203 and 246.
In regards to the allegation Facility staff are not addressing resident's medical condition, based on interviews conducted and information gathered it was revealed through discharge papers from PIH hospital that R1 on 11/20/2022 was observed by a medical doctor who prescribed Elmite topical cream 5% with a diagnosis of rash on body/itchy.
Facility charting notes specify that R1 received Elimite Treatment for itchy skin and housekeeping

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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 28-AS-20221208153132

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: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 12/14/2022

NARRATIVE

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deep cleaned the room and R1's clothes were washed/heat treated.
Interviews with R2-R7 who all stated that staff do a great job administering their medication and they have never missed a dose. Stated that staff have never made a mistake administering medication
Stated that staff are very friendly and attentive.
Interview with R1 who stated that scabies was obtained 18 years ago in Seattle, Washington.
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 Facility staff do not answer resident's call button at night, based on interviews conducted and information gathered LPA along with Assistant Administrator toured the following Rooms at 11:15 AM:102, 118,125, 201, 203 and 246. and tested the call button in the restroom and the phone in all residents rooms that were toured. Both the call button and phone were operable and in good working condition. Caregiver responded immediately when LPA tested their phone or call button.

Interviews conducted with R2-R7 who all stated that staff does a good job assisting residents with all their needs and when they pushed the call button or used the phone that staff assisted promptly and are always friendly and willing to provide assistance.

Staff interviewed stated that they do answer all calls promptly and will have to determine the urgency of the call and will respond in a timely manner.

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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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