198601962-11-3-2023-28-AS-RORN-CXRVXN-20231120154950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:05:19 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
10/27/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231027123826

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: 52	DATE:	11/03/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Victoria Tran		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are permitting resident to smoke in their room.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit.

LPA toured the physical plant, interviewed the administrator, staff #1-#2, resident #1-#5, and requested a copy of staff roster, and resident roster.

Regarding allegation: Staff are permitting resident to smoke in their room. LPA Wesley interviewed Administrator Victoria Tran who stated that resident #1 doesn't smoke in their room, LPA interviewed the Wellness directors who said that resident #1 doesn't smoke in their room because her staff would tell her when they do their rounds. Wellness director also indicated that resident #2 brags and tells staff that she calls licensing all the time. LPA interviewed resident #1 and they said they do not smoke in their room.
(Continued on LIC 9099C)

continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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-20231027123826

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: 11/03/2023

NARRATIVE

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Resident #1 also denied drinking in their room getting drunk, and said their neck is not broken but it is fractured and they have hardware in place. If an individual were to look at the resident they couldn't tell their neck was broken and they are in an electric wheelchair. LPA Wesley went to resident #1's room and did not observe an odor or didn't see any indication that there was liquor(bottles in trash, cigarette buds trash, ash tray, ashes, cigarette holes in the bedding). Resident #2 said they have a fear of fires and purchased a fire extinguisher in case a fire breaks out in the facility. Staff confirmed that resident #2 had a fear of fires from childhood and may be paranoid that a fire will break out. Residents #3-#5 were interviewed and said they do not smell any smoke or didn't see, or hear of any residents getting drunk in the facility. LPA Wesley interviewed staff #2 who is a caregiver. They have indicated the resident smells like cigarettes because it lingers in their clothing, when they are out of their room it doesn't smell like cigarettes and they have never seen or heard of the resident drinking or getting drunk in the facility.

Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation is found to be Unsubstantiated.

A copy of this report was given to the Administrator Victoria Tran.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

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