198601962-3-28-2021-28-AS-MVAO-BZLQUZ-20210330122936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 03/01/2021
Date Signed: 03/28/2021 05:46:28 PM

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
08/28/2020 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200828103333

FACILITY NAME:	SOUTHLAND LIVING		FACILITY NUMBER:	198601962
ADMINISTRATOR:	TRAN, VICTORIA		FACILITY TYPE:	740
ADDRESS:	11701 STUDEBAKER ROAD		TELEPHONE:	(562) 406-7326
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	75	CENSUS: 44	DATE:	03/01/2021
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Victoria Tran		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff locked residents out of facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Victoria Tran.

The investigation consisted of the following: On September 03, 2020 LPA Wesley conducted a telephonic interview and requested copy of: staff roster, resident roster, visitation policy, house rules, and information in the plan of operation as it relates to automatic door locks to be faxed/emailed by 09/04/20. LPA also interviewed the Administrator Victoria Tran, staff #1-2(S1-S2), resident #1-#6(R1-R6) regarding the above mentioned allegation.

Investigation revealed the following: During the interviews, R1 said they were locked out the facility before 8pm,
Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2021

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-20200828103333

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: SOUTHLAND LIVING	FACILITY NUMBER: 198601962
	VISIT DATE: 03/01/2021

NARRATIVE

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and that staff #2 locks the facility doors between 6:30-7:30pm. The interviews with R2-R5 were all consistent in saying they have never been locked out of the facility, and resident and staff also complained that R1 is rude and is always beating the doors and cussing out the staff. R2-R5 informed the LPA that the facility has automatic doors that lock at 8pm and the inside patio doors stay open day and night so that residents can smoke in the designated smoking areas. The Administrator Victoria Tran confirmed that the facility doors automatically locks at 8pm and that R1 disregards the house rules and often returns to the facility past 9pm which causes the staff and residents complain about the pounding and kicking that R1 does to the facility door to gain entrance and how it is unfair that R1 gets away with breaking the house rules and they don't. During the interview with S1 they informed the LPA that R1 accused them of locking the door at 8pm in which they informed R1 that the doors automatically lock at 8pm. S1 also said when they are on the floor administering medication in hall 3, R1 can be heard kicking and banging on the facility door and when S1 opens the door, R1 yells at them, calling them scary for locking the door, and uses foul language when speaking to them. During the interview with S2, they also indicated that R1 stays out past hours, and when they return to the facility after pounding on kicking on the doors, R1 yells and calls staff bad names and the residents complain. S2 advised that the outer doors automatically lock at 8pm and the inside doors that lead to the patio remains unlocked so residents can access the smoking area. There is no evidence to support the allegation: Staff locked residents out of facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A telephonic exit interview was conducted with Administrator Victoria Tran, and a hard copy was provided via email to obtain signature. There are no citations issued, exit interview conducted.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2021

LIC9099 (FAS) - (06/04)

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