198601838-5-17-2022-28-AS-LHIS-CFDRYL-20220614132630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 05/17/2022
Date Signed: 05/17/2022 12:48:12 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
05/11/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220511165338

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: 98	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Michele Goodney, Administrator		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Facility not cleaned properly.

INVESTIGATION FINDINGS:

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On 5/17/22 at 9:05 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint to the facility. Upon arrival LPA met with Michele Goodney (Administrator) and explained the purpose of the visit.

During today’s visit, LPA toured the facility with administrator, maintenance director and housekeeping supervisor. LPA obtained resident/ staff roster, Kitchen cleaning schedule, weekly deep cleaning schedule, Janitors duties, housekeeping duties, Oasis (memory care unit) deep cleaning schedule, Restroom daily cleaning log, breakroom cleaning log, Elevator cleaning log. LPA interviewed residents R1 - R8. LPA Interviewed administrator and Staff S1- S9.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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-20220511165338

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: 05/17/2022

NARRATIVE

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The investigation reveals the following: In regard to "Facility not cleaned properly", it is alleged that the facility does not clean the facility and resident’s room. It is also alleged that laundry room floors are dirty and contains old mops and buckets with dirty water. During the visit LPA toured the facility and observed laundry/ cleaning cart located in the hallway with clean water. Laundry room was observed cleaned. Residents bedrooms was clean at the time of visit. 6/8 residents confirmed daily cleaning and weekly deep cleaning done by the facility. 6/8 residents also confirmed that they are satisfied with the cleaning. 9/9 staff interviews confirmed daily cleaning and weekly deep cleaning.

Based on LPA's interviews, 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 with Marlin Fish and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

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