198601838-2-15-2025-28-AS-RORN-DE2LK5-20250219074856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 01/24/2025
Date Signed: 02/15/2025 12:39:59 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
12/11/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241211130441

FACILITY NAME:	DOWNEY RETIREMENT CENTER		FACILITY NUMBER:	198601838
ADMINISTRATOR:	BRANDIE MENDIBLES		FACILITY TYPE:	740
ADDRESS:	11500 DOLAN AVENUE		TELEPHONE:	(562) 869-2416
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	252	CENSUS: 127	DATE:	01/24/2025
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Brandie Mendibles - Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff did not dispense medication as prescribed.
Staff did not provide residents with medical attention in a timely manner.
Staff are not providing activities for residents in care.
Facility is in disrepair.
Staff did not ensure that facility was kept clean.
Facility is malodorous.

INVESTIGATION FINDINGS:

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***This report is an amended version of the report dated 1/24/2025. The reason for the amendment is to remove confidential information. The findings will remain the same.***

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Jason Perez (Assistant Administrator) and explained the purpose of today's visit.
The investigation consisted of the following: On 12/19/2024 LPA conducted initial 10-day visit and obtained copies of staff & resident rosters. LPA toured facility along side of Jason Perez, toured memory care area and various resident rooms in memory care, tested thermostats in 4 memory care resident rooms, obtained copies of Activity Calendars from Oct-Dec 2024, conducted medication review, obtained copies of Carting Notes for Resident #1 (R1) and interviewed 4 staff (S1-S4) and 15 residents (R1-R15). During subsequent visit 1/24/2025 LPA interviewed S1, reviewed R1's medication, Toured memory care area and tested delay egress on all exit doors, and inspected R1's patio doors in private room. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20241211130441

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: 01/24/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not dispense medication as prescribed.
It is alleged that R1 is often not provided her medications on time, sometimes waiting for hours. The RPs stated that R1 is supposed to receive their medications at 5 PM, but staff frequently do not provide them until 8 - 9 PM. LPA reviewed R1’s medication and the Medication Administration Record (MAR), records indicated that resident often times refuses medication which then pushes out the time that resident is scheduled to take the medication. Due to resident frequently visiting with family there are some missing information on the MAR since family administer the medication while resident is away. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation, stating that medication is administered on time and as prescribed by physician. LPA interviewed S2 and S3 who work directly with medication and it was revealed that R1’s Power of Attorney (POA) has specific instructions to not wake resident up for medications, changes or showers. LPA spoke with family and this was confirmed, however, the instruction to not wake resident for medication was denied. Interviews with S2 and S3 also revealed due to R1 sometimes refusing medications in the morning, this does interfere with the time that medication is given and pushes out the next dose later, residents do have a right to refuse medication and it was confirmed that although after refusing there are attempts to encourage residents to take their medication, however, there are times that the encouragement is not successful and notes are documented in the residents file (which LPA observed during file review). LPA interviewed 15 residents and 13 out of 15 residents denied the above allegation, stating that they are given their medication as prescribed by physician. Additionally, LPA reviewed a total of 8 residents medication with no issues observed.

Allegation: Staff did not provide residents with medical attention in a timely manner.
It is alleged that R1 had pink eye which is believed to be contracted by R2 and neither resident received medical attention from staff. During medication review LPA observed both R1 and R2 to have medication treating the eyes on both residents. Interview with POA revealed that staff are not able to make medical appointments or contact pharmacy for R1, therefore, POA was the person who assisted R1 with visiting a physician for medication and assessment of eye, POA stated that they were told at the first signs of R1’s eye being glossy and a visit with physician was made right away. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation.
(continued on LIC9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20241211130441

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: 01/24/2025

NARRATIVE

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(continued) Allegation: Staff did not provide residents with medical attention in a timely manner.
Interviews with S2 and S3 revealed that family was contacted once the first signs of R1’s eye being glossy and family arranged a visit with physician as staff are not allowed to make appointments or call on behalf of the resident for medication, both staff confirmed the only time they are able to assist with medical needs for R1 is in the case of emergency which was also confirmed by POA during conversation with LPA. During file review LPA observed notes in R1’s file that detailed what staff observed the watery eye, when, and that family was informed immediately. LPA interviewed 15 residents and 14 out of 15 residents denied the above allegation, stating that they are provided with medical attention in a timely manner.
Allegation: Staff are not providing activities for residents in care.
It is alleged that residents have not been offered any activities and are confined to the dining room or TV area throughout the day. LPA toured dining room (which is also used as the activity room) and observed a sufficient amount of supplies for activities. LPA reviewed activity calendar and there appeared to be sufficient activities scheduled throughout the day. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that activities are provided to residents throughout the day. Interview with S4 revealed that activities are provided and encouraged for residents to participate in, often times residents in the memory care area are assisted to the assisted living area to be included in those activities, S4 also stated that when residents in the memory care area want to go for a walk and if weather permits, staff will take residents for a walk (LPA observed residents from memory care being assisted with staff for a walk during initial visit).
Allegation: Facility is in disrepair.
It is alleged that the thermostat in the memory care area is broken or non-functional, that the exits within the memory care side have delayed egress that are non-operable and that the patio screen door within R1’s room does not close. LPA toured memory care area along side of S1 and thermostats throughout the area appeared to be operable, LPA entered 4 residents rooms (including R1’s room) and each thermostat was operable and tested by S1 during visit. R1’s patio doors were inspected and both the glass door and screen open and closed properly with no issues. LPA also tested each exit within the memory care area (including door that leaves to patio) and all exits were observed to have the delayed egress in operating condition with alarms that sounded. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that housekeeping regularly checks the thermostats in residents rooms and there haven’t been any reports of any not working, staff also stated that there has not been a time where the delayed egress was non-operable and those are tested regularly as well. During initial visit LPA observed a resident trying to leave through one of the side exits and the delayed egress sounded and staff were able to redirect resident with no issues. (continued on LIC9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20241211130441

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: 01/24/2025

NARRATIVE

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Allegation: Staff did not ensure that facility was kept clean.
It is alleged that facility floors within memory care are sticky due to incidents involving residents, and staff have not properly cleaned the spills. LPA toured memory care area and floors to appeared to be clean and not sticky. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation, stating that if there is ever a spill the area is monitored and cleaned immediately by housekeeping or maintenance. LPA interviewed 15 residents and 15 out of 15 residents denied the above allegation, stating that the facility is cleaned regularly and floors are not sticky.

Allegation: Facility is malodorous.
It is alleged that there is a smell of urine throughout the memory care are of the facility. LPA toured memory care area and did not observe any smell of urine, floors were also observed and there was no indication of spill or urine on floors. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that the facility is kept clean and free from odors. LPA interviewed 15 residents and 14 out of 15 residents denied the above allegation.

Based on statements and interviews conducted with staff/residents, review of resident medication, and tour of memory care of facility, 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 held, and a copy of this amended report was provided to Brandie Mendibles.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

LIC9099 (FAS) - (06/04)

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