198601838-10-5-2023-28-AS-LHIS-D2MNM7-20240220093441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:39:06 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
09/25/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230925142442

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: 129	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Brandie Mendibles		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident
Staff was sleeping while providing care and supervision
Staff yelled at a resident while in care
Staff behavior poses as a risk to a resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA's) Nicol Wesley conducted an initial 10 day complaint visit and met with Administrator Brandie Mendibles to discuss the reason for today's visit.

Investigaton consisted of: Interviews with staff, interviews with residents, interviews with R1 husband, obtained a copy of the resident roster, staff roster, and charting notes. LPA Wesley look at the file for resident #1 and file for LVN Olusola "Henry" Awolpe.

Regarding allegation: Staff did not seek timely medical attention for a resident. R1 indicated that she and her husband went to have her vitals taken and the African American med tech was falling asleep while taking her vitals. LPA Wesley saw a video and it did not seem as though the Nurse was falling asleep. He blinked his eyes for 1 second and he was wearing a mask and he was also walking around and attentive. Staff and

Continued on LIC 9099c.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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-20230925142442

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: 10/05/2023

NARRATIVE

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the Nurse indicated that the resident's husband don't care for African Americans and said the husband said things like they were going to make sure he gets his license taken away. They also made allegations to imply that they don't like the Health and Wellness Director for reasons of the same nature. The resident also claims that they Nurse and Wellness Director are both related. The Administrator and Wellness director said the Nurse is not related to them in any way. She said the resident have made it known that they dont like black people and they say things in Spanish like those people, you people, that black person. LPA Wesley saw the video and didn't see the Nurse falling asleep, he was walking around the office, attentive and when I asked to see the video again, because I didn't see the resident sleeping, R1 said that's okay never mind and her husband was on the phone speaking loud and said you know what, "you People," LPA Wesley asked, what are you saying "you people" who are you referring to, his wife began apologizing. I explained if you don't let me see the video how can i justify what you are saying? LPA interviewed 6 out of 7 residents who stated that they haven't had any problems with Staff did not seek timely medical attention for a residents in a timely manner and the Nurse gets them medical attention in a timely matter.

Regarding allegation Staff was sleeping while providing care and supervision. LPA observed the video from the residents husband and did not see the Nurse falling asleep, when the LPA wanted to see the video again for clarification they husband and wife refused. The R1 indicated that the Nurse goes to sleep in his car, and the Administrator and Wellness Director said the Nurse can do whatever they choose to on their lunch break they work the PM shift. LPA interviewed 6 out of 7 residents who said they never saw staff including the nurse fall asleep, or go to sleep on duty.

Regarding allegation: Staff yelled at a resident while in care, and Staff behavior poses as a risk to a resident R1 indicated the night they came back from the hospital they refused to be seen by the Nurse to take her vitals and get her situated in her room, and they sent Med Tech #1 in to take her vitals. R1 said the Wellness Director came to her room and was yelling as to why she didn't want the Nurse to take her vitals and R1 told her that its not good for her heart for the Wellness Director to be yelling at her. The Wellness Director said that she questioned R1 as to"How was it possible for the Nurse to fall asleep?" then R1 asked for her to leave the room. LPA interviewed 6 out of 7 who said that staff doesn't yell at them which includes the Wellness director and they do not pose a risk to the residents in care.

LPA asked R1 for the dates she went to the hospital because the records show the last hospitalization was on 07/13/23 and 07/15/23 and the date on the video is 07/21/20.R1 said her husband had the paper work
Continued on LIC 9099C page2

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230925142442

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: 10/05/2023

NARRATIVE

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husband had the paper work and its at her house. she will get the exact dates a refile. LPA Wesley tried to assist but without the evidence that she is referring to there's nothing I could do.

Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegations are found to be Unsubstantiated.

A copy of this report was given to the Administrator .

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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