198601962-10-20-2023-28-AS-RORN-CY3M3W-20231130081545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:28:16 PM

Unfounded

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
10/13/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231013090742

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:	10/20/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Victoria Tran		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are making inapprorpiate comments towards resident.
Staff yelled at resident.
Staff are not providing resident with comfortable accomodations.
Staff are not applying resident's medication.
Staff are not meeting resident's walking needs.
Staff are not providing adequate food service to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) 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, interview Administrator, and requested a copy of staff roster, resident roster.

Regarding allegation:Staff are making inapprorpiate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accomodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident. During the interview with Administrator she advised that none of her staff are required to walk the residents. LPA then looked at the resident roster and staff roster and did not see any of the names on the list that was
continued on LIC 9099C.

Unfounded

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: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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-20231013090742

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: 10/20/2023

NARRATIVE

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spoken about on the back on the LIC 802(Complaint Report). The complaint is for the SNF(Skilled Nursing Facility) that is located next door.

Based on the information gathered during this visit, the allegation(s): Staff are making inappropriate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accommodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident are deemed UNFOUNDED.

A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Therefore, we have dismissed the complaint. Exit interview conducted with Administrator Victoria Tran and a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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