198601838-3-30-2023-28-AS-MVAO-CRUPMP-20230515112641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 03/30/2023
Date Signed: 03/30/2023 04:29:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/28/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230328091709

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: 120	DATE:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Brandie Mendibles - Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility not providing adequate supervision resulting in resident suffering multiple falls.
Facility did not clean up resident's urine.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Jason Perez, Assistant Administrator and explained the reason for the visit. Administrator, Brandie Mendibles arrived at 11:15am and assisted with the investigation.

The investigation consisted of the following: LPA toured the facility including Memory Care Unit and common areas, R1's room and obtained copies of Staff & Resident Rosters, Staff Daily Shift Reports and Notes (March 2023), Random Resident's Room Checks Reports (March 2023). LPA reviewed Resident #1 (R1) file and obtained copies of the following Face Sheet, Physician's Report, Admissions Agreement, Pre-placement Assessment, Transfer/Discharge Report, Incident Reports (3/22/23, 3/24/23, 3/25/23 and 3/26/23). LPA interviewed Resident #2 (R2) - Resident#10 (R10) and Staff #1 (S1)- Staff #7 (S7). R1 could not be interviewed as R1 is currently living with a family member outside the facility and will not be returning back to the facility until 4/3/2023.
*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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-20230328091709

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 03/30/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation, "Facility not providing adequate supervision resulting in resident suffering multiple falls.", it is alleged that a resident sustained multiple falls while in care of the facility. The resident has been suffering from Alzheimer/Dementia for the last "15 years." All staff members interviewed denied the allegation and stated that there's enough staff to check and attend to the needs of the residents on a daily basis. S1 stated that she ensures that the facility is fully staffed to provide proper care and supervision to facility residents. Staff members interviewed also stated that when a resident needs assistance, they use either the house phone or the pull out cord in the residents room to call. The call goes directly to the front desk and staff would use the radio to alert staff on the floor to assist the residents. At 1:30pm, LPA tested the pull out cord in a random room and staff came in 4 mins 37 secs. LPA observed enough staff caring for residents in Memory Care and Assisted Living during the visit. Based on documents reviewed, R1 has multiple falls for a period of 5 days in the facility, however, this is not due to lack of adequate supervision. The staff conduct a routine safety checks often and facility has cameras in the Memory Care unit and common areas that are operational. There are (3) Caregivers and (1) Med-Tech on schedule per shift (AM, PM and NOC shifts) who provide care and supervision to the residents. S1-S2 stated that R1 fell at the previous facility the night before being transferred to their facility. On 3/22/2023, R1's transfer date, S1 re-evaluated R1 immediately upon arrival because she observed a bruise on her nose/nostrils area and S1 had her transferred to the Hospital for evaluation. S1 stated that R1 does not have a one-on-one caregiver. S1 will meet with R1's family on 4/03/2023 to discuss her higher level of care and to possibly move her to a different facility that can meet her needs for higher supervision. S1 stated that all staff are aware that R1 needs higher supervision and extra monitoring. (9) out of (9) residents interviewed denied the allegation. All interviewed residents indicated that they feel there is sufficient staff to provide adequate supervision and monitoring to meet their needs. Residents interviewed indicated they feel safe and comfortable at this facility. Therefore there was insufficient evidence to corroborate with the allegation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230328091709

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 03/30/2023

NARRATIVE

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In regards to the allegation, "Facility did not clean up resident's urine." it is alleged that a resident suffered an additional 2 more falls due to the resident got up and went into another resident's room, the floor was wet because of the other resident's pee, she tripped and fell.” All staff members interviewed stated that there's enough staff scheduled to clean the residents rooms. Staff members indicated that room cleaning is done on a daily basis and as needed. Housekeepers are always available if called upon to clean and constantly walks around to do cleaning and chores for the residents. S1 stated that she ensures that the facility is clean and safe to avoid any threats or accidents to facility residents. S4 stated that part of her job is to clean the residents room which includes sweeping,mopping and dusting. S1-S2 indicated that staff conduct routine and safety checks in the facility to avoid risks or danger to residents. LPA did not observe any foul odor or spills on the residents rooms and common areas during the visit. (9) out of (9) residents interviewed denied the allegation. All interviewed residents indicated that the housekeepers do a good job in cleaning their rooms daily. Residents interviewed indicated that staff do deep cleaning on a weekly basis. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations.

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, a copy of this report was provided to the Facility Administrator, Brandie Mendibles.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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