198601838-6-29-2023-28-AS-FFIS-CTDSVL-20230703141254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 06/29/2023
Date Signed: 06/29/2023 01:16:59 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
11/05/2021 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211105102142

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:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Jason Perez (Assistant Administrator)		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not meeting the needs of the resident.
Staff is not sufficiently managing incontinence care for resident.
Food service is inadequate.
Staff are rude to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with Jason Perez (Assistant Administrator) and explained the purpose of the visit.

During the initial visit on 11/10/21, LPA obtained a copy of the Staff schedule, Resident roster and food menu. LPA interviewed Staff #1 in the office at 10:14am, toured the kitchen with Staff #1 at 10:35am, interviewed Residents #2 to #9 in the office between 10:57am to 12:36pm and interviewed Resident #10 and #11 in their bedrooms between 12:45pm to 1:13pm.

During today's visit, LPA obtained/reviewed a copy of the Staff Schedule/Resident Roster, Shower schedule and the food menu. LPA toured the kitchen with Staff #2 and interviewed Staff #2 to #10 in room 101.

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: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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-20211105102142

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: 06/29/2023

NARRATIVE

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In regards to the allegation: Staff are not meeting the needs of the resident. Interviews with 10 of 10 Residents indicate their needs are being met which includes bathing assistance, incontinence assistance and food service. Interviews with Administrators and care giving Staff also indicate Resident needs are met.

In regards to the allegation: Staff is not sufficiently managing incontinence care for resident. Interviews with 10 of 10 Residents indicate there is sufficient Staff and sufficiently managing there incontinence needs. Interview with care giving Staff indicate there is sufficient Staff to meet Resident's incontinence needs. Staff and Bathing schedule indicate there is sufficient Staff to meet Resident needs.

In regards to the allegation: Food service is inadequate. Interviews with 10 of 10 Resident indicate food is adequate and of good quality. Interviews with kitchen Staff indicate Residents are served breakfast, lunch and dinner and food is of healthy quality. Review of the food menu indicate breakfast, lunch and dinner is provided and of sufficient quantity. Tour of the kitchen indicate food is of sufficient supply and of good quality.

In regards to the allegation: Staff are rude to residents. Interview with 10 of 10 Resident indicate Staff is not rude to them and did not witness Staff being rude to other Residents. Interviews with 10 of 10 Staff denied being rude to Residents and have not witnessed current Staff being rude to other Residents.

Based on LPA's observations, record review and interviews, the investigation revealed: Although the allegations may have happened or is 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 with Jason Perez (Assistant Administrator) and a copy of this report provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC9099 (FAS) - (06/04)

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