198601962-9-29-2023-28-AS-LHIS-CYNL4J-20231219072535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 09/28/2023
Date Signed: 09/29/2023 09:40:18 AM

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
09/20/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230920143231

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:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Victoria Tran		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff made resident feel uncomfortable.
Staff is stealing resident personal belongings.

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 residents #2-#6 and staff #1-#2, interview Administrator, and requested a copy of staff roster, resident roster, and copy of the check form for body check conducted on 08/14/23. LPA attempted to interview resident #1 via phone and in person but was not successfull.

Regarding allegation: Staff made resident feel uncomfortable. LPA Wesley interview #2 out of #6 residents who stated they wasn't uncomfortable with the body checks that were conducted, Interviewed staff #1 who stated resident #1 approached her and staff #2 in their office and told them I heard you were looking for me to do a body check, and the resident took all of her clothes off and bent over. She said I dont want to catch
(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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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-20230920143231

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: 09/28/2023

NARRATIVE

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any of that. The interview with staff #2 was consistent with staff #1 and she also said, just go ahead a check me. The body checks that were conducted were voluntary and the resident can deny if they wanted.

Regarding allegation: Staff is stealing resident personal belongings. LPA interviewed staff #2-staff #6 and they all stated that the staff has not stolen any of their personal belongings, haven't heard of the staff stealing anyone's personal belongings. LPA Interviewed the administrator, staff #1, and staff #2 and they indicated that they have never stolen any resident personal belongings, never heard of any residents stealing anyone's personal belongings, and would notify and report it to someone if they did hear of them stealing.

Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegations are 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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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