198601838-10-21-2022-28-AS-MVAO-CL8RLT-20221116120739

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 10/21/2022
Date Signed: 10/21/2022 12:26:03 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
08/18/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220818134917

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: 114	DATE:	10/21/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Administrator Michele Goodney		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility is not following proper Covid-19 safety protocols.
Staff are not providing resident all of their meals.

INVESTIGATION FINDINGS:

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On 10/21/2022 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the allegations listed above. The initial complaint visit was conducted by LPA Baptiste on 08/22/2022. LPA met with Administrator Michele Goodney and explained the reason for the visit.

During the initial visit LPA Baptiste toured the facility with administrator, obtained resident/ staff roster, and infection control plan. LPA Interviewed administrator, Staff S1, and S2.

During today’s visit LPA obtained staff and resident roster and tested the phone system in rooms 104,107,206,209 and 233. LPA interviewed Residents R1 through R12.

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: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

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-20220818134917

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: 10/21/2022

NARRATIVE

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The investigation reveals the following: Regarding “Facility is not following proper Covid-19 safety protocols”, it is alleged that the facility allows several residents with Covid-19 to walk around the facility and sit in the common areas without a mask . It is also alleged that the facility is not monitoring the residents with COVID-19. During the visit LPA observed staff and residents wearing surgical masks. LPA also observe infection control and social distancing signs. The interview with Administrator revealed that during the outbreak some residents tried to sneak out of isolation but was always redirected and never socialized in the common areas. 2/2 staff stated the COVID positive residents was always in Isolation and if they saw a resident out of isolation they were always redirected. 1/12 residents stated they have seen COVID positive residents and the staff did not redirect the residents back into isolation. 3/12 residents stated all residents was in Isolation and only witness staff walking around. 3/12 residents stated some residents sneaked out but was redirected by staff back to there isolation room. 3/12 residents stated they were in isolation for 14 days and did not witness other residents leaving their isolation rooms. 2/12 residents do not recall residents leaving their isolation rooms.

The investigation reveals the following: Regarding “Staff are not providing resident all of their meals” it is alleged that R1 was not given one of there meals and it maybe due to the phone being in disrepair. LPA tested the phone system in 5 residents’ room and confirmed the phone lines was working condition at the time of the visit. Interview with the administrator confirmed the phone lines is old but all are in working condition. 2/2 staff stated the phone lines are in working condition. 1/12 residents stated the phone lines are in disrepair. 11/12 residents confirmed they received 3 meals a day and 2 snacks. 5/12 residents stated the phone in their room is operational. 6/12 residents stated their phone is operational but if the phone line is not hanged up properly or if someone is on the phone they will not get through. 6/12 residents stated staff has come to their room numerous times to inform them that their phones are off the hook.

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 Administrator Michele Goodney 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: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

LIC9099 (FAS) - (06/04)

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