198601962-6-22-2022-28-AS-LHIS-CGXU5Y-20220803151732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 06/22/2022
Date Signed: 06/22/2022 01:53:57 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
06/13/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220613152732

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: 45	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Victoria Tran		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility is not being cleaned
Residence bedding not changed timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Victoria Tran who assisted with the visit.

Regarding the allegation that facility is not being cleaned, the investigation consisted of tour of facility, including resident rooms, interview(s) with Administrator and Staff #1- Staff #4, and Resident #1 - Resident #5. Administrator and Staff interviewed denied the allegation. Staff stated that the facility is being cleaned daily, and resident rooms are cleaned once per week, and more often if needed. Residents interviewed were unable to corroborate the allegation. 4 out of 5 residents stated that the facility staff do clean the facility, and they stated that resident(s) rooms are cleaned weekly, and more often if needed. During the facility tour, LPA observed that the facility and resident rooms appeared to be clean. Regarding the allegation that residence bedding is not changed timely, the investigation consisted of tour of facility, including resident rooms, interview(s) with Administrator and Staff #1- Staff #3, and Resident #1 - Resident #5.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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-20220613152732

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: 06/22/2022

NARRATIVE

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Staff interviewed denied the allegation. Staff stated that resident(s) bedding is changed once per week, and more often if needed. Residents interviewed were unable to corroborate the allegation. 5 out of 5 residents stated that facility staff do change their bedding or residents change it themselves if they choose to. LPA observed that resident(s) bedding appeared to be clean during room tour(s).

Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Victoria Tran.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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