198601962-8-28-2023-28-AS-RORN-CVLLFW-20230912084348

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 08/28/2023
Date Signed: 08/28/2023 02:55:44 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
08/25/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230825095443

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: 53	DATE:	08/28/2023
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Administrator Victoria Tran		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not administer resident's medication as prescribed
Staff do not ensure a comfortable living environment for resident
Staff violated residents personal rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with assistant administrator Zachary Miller and the purpose of the visit was discussed. Administrator Victoria Tran arrived shortly after.

On todays visit, LPA toured the physical plant, interviewed staff #1-#5 (S1-S5) and Residents #1-6 (R1-R6). LPA collected documents from R1's file such as: Facesheet, physicians report, needs and services plan, medication list and medication log for the month of august. LPA collected a copy of the staff and residents roster as well as a copy of the list of body checks conducted on 8/14/23 for the residents of the facility. The investigation revealed the following:

In regards to the allegation "Staff do not administer resident's medication as prescribed" it was alleged that staff provided R1 an extra dosage of apriprazole (Abilify) causing R1 to be overmedicated this month. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation... Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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 2

Control Number 28-AS-20230825095443

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: 08/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews show that R1 is only provided what is prescribed and nothing more or nothing less unless they refuse medications. There was no documentation of medication errors for R1 or of staff noting issues with R1 due to medication for the month of August. LPA reviewed notes from staff stating that R1 requested an extra dosage of abilify on 5/26/23 but was refused due to them already receiving the required amount by physicians orders. Interviews do not show that R1 was overmedicated. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation. 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.

In regards to the allegation "Staff do not ensure a comfortable living environment for resident" it was alleged that S1 and S2 raise the volume of the music in the dining room to make R1 uncomfortable and have auditory hallucinations. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews with residents and staff does not show that staff are purposely making residents uncomfortable in the facility. Staff interviewed denied turning up the volume in the dining room to make R1 uncomfortable. (5) of (6) residents stated they have never seen staff attempt to make R1 uncomfortable to they may leave and go to their room. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation. 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.

In regards to the allegation "Staff violated residents personal rights" it was alleged that staff of the facility conducted body checks on residents on 8/14/23 and inappropriately touched R1. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews state that the staff the facility attempted to conduct skin checks on all residents of the facility on 8/14/23 for rashes due to possible exposure to scabies. Interviews with staff and residents state that it was not forced and it was voluntary. Interviews do not show that staff inappropriately touched residents who participated and no one had an issue with being asked as they understood the reason for the check. Interviews also show that R1 agreed to the body check but after the fact, got upset that the staff were doing that to residents. LPA reviewed documentation of roster from 8/14/23 listing residents who were checked and there were names of residents who refused. This shows residents were not forced to let staff conduct skin checks. Interviews with (5) of (6) residents stated that staff did not put hands on them or violated their personal rights. S1 and S3 were present during R1's skin check and they denied touching R1 inappropriately. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation. 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 and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2