198601838-5-30-2023-28-AS-RORN-CSCV7Y-20230531161155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 05/30/2023
Date Signed: 05/30/2023 09:46:56 AM

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
04/17/2023 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230417092501

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: 125	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Veronica De Hoyos (Activities Director)		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff handle resident in a rough manner.

INVESTIGATION FINDINGS:

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***This investigation report LIC9099 supersedes report LIC9099 dated 04/25/23.***

Licensing Program Analyst (LPA) Kruz Long conducted a visit to supersede the report dated 04/25/23 for the allegation listed above. LPA met with Veronica De Hoyos (Activities Director) and explained the purpose of the visit. The investigation consisted of the following:

During a visit conducted on 04/25/23, LPA obtained a copy of the Staff/Resident rosters, interviewed Staff #1 to Staff #5 in room #101 and interviewed Residents #1 to Residents #10 in room #101.

In regards to the allegation: Staff handle resident in a rough manner. Interviews with 5 of 5 Staff denied handling a Resident in a rough manner and have never witnessed other Staff handle Residents in a rough manner. 2 out of 10 Residents interviewed indicate Staff has handled them in a rough manner. 8 of 10 Residents indicate they have never been handled in a rough manner by Staff nor have they seen Staff handle Residents in a rough manner. Continue to LIC9099C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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-20230417092501

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: 05/30/2023

NARRATIVE

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***This investigation report LIC9099C supersedes report LIC9099C dated 04/25/23.***

Based on LPA's interviews, the investigation revealed: 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.

Exit interview conducted and a copy of this report provided to Veronica De Hoyos (Activities Director).

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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