198601962-3-20-2025-28-AS-LHIS-DFMTLC-20250411144920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 03/20/2025
Date Signed: 03/20/2025 08:03:42 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
02/25/2025 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250225153248

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: 50	DATE:	03/20/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Victoria Tran		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Staff do not ensure that resident's incontinence needs are met.
Staff do not answer resident's call button in a timely manner.
Staff did not distribute resident's medication as prescribed.
Staff did not consult with responsible party regarding resident's care.
Staff handles residents in a rough manner.

INVESTIGATION FINDINGS:

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

Investigation consisted of: requested a copy of the staff and resident roster, interviewed the Administrator, requested to see resident 1,2,3 files, and requested specific copies of documents, interviewed

Regarding allegation: Staff do not ensure that resident's incontinence needs are met. LPA Wesley interviewed resident 4 out of 5 residents who indicated that the staff meets their incontinence needs and they dont have any problems. Resident #1 uses the restroom frequently and staff indicated that the resident called 20 times per day and they are constantly taking the resident to the restroom. Staff did not remember leaving the resident in soiled undergarments on 09/28/24 & 11/20/24 and residents #2-#5 all confirmed that
continued on LIC 9099C page 2.

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: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

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 3

Control Number 28-AS-20250225153248

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: 03/20/2025

NARRATIVE

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they have never been left in soiled undergarments, and the staff are pretty good with changing them. Staff all said that they change the residents in a timely manner.

Regarding allegation: Staff do not answer resident's call button in a timely manner. LPA Wesley interviewed Staff and they said that they answer all residents calls in a timely manner. LPA Wesley was in the facility and pressed the call button and it took staff one minute and twenty two seconds to come and assist. Resident #1 uses the restroom frequently and staff indicated that the resident called 20 times per day and they are constantly taking the resident to the restroom. Resident's #2-#5 where interviewed and they indicated that the staff answers their calls in a timely manner.

Regarding allegation: Staff did not distribute resident's medication as prescribed. LPA Wesley interviewed residents #1-#5, and 4 out of 5 residents indicated that the Medical Technician gives the residents medication in a little medicine cup, with water on time, and they never missed any medication. On 10/30/24 resident #1 loved one saw a pill on the floor & 11/21/24 found a another pill on the floor. Staff said they think that the resident took the pill out of their mouth or the medication fell from the cup, but they did confirm that they give all medications as prescribed according to doctors orders.

Regarding allegation: Staff did not consult with responsible party regarding resident's care. LPA Wesley interviewed the staff who said that resident #1's Primary Treating Physician kept requesting for the resident to see a Neurologist this has been going on for about 1 month and a half. So the Primary Treating Physician asked the Wellness Director to schedule the appointment and they consulted with Resident #1's loved one and she said that she would agree with the appointment as long as it is with a Spanish speaking Neurologist. The Wellness Director scheduled the appointment, and resident #1's loved one canceled the appointment because the appointment was in Orange County and she was afraid her mom would use the bathroom. LPA interviewed residents #2-#4 and they indicated they have never experienced a problem like that but if they did, it wouldn't be a problem because the facility staff cares about the residents and are seeking medical attention because they have to.

Regarding allegation: Staff handles residents in a rough manner. Resident #1's loved one indicated that staff #3 handled resident in a rough manner and left bruises on her body, and they told LPA Wesley that staff #4 handled resident in a rough manner leaving bruises on her body.
Continued on LIC 9099C Page 3.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250225153248

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: 03/20/2025

NARRATIVE

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LPA Wesley Interviewed residents #2-#4 and they've indicated that staff #3 and #4 have never handled them in a rough manner and left bruises on them. LPA Wesley interviewed Staff #3 and #4 and they denied handling the residents in a rough manner, or Leaving bruises on them. Staff said that they have to perform body checks on residents during showers and changing and have never saw any bruises on resident #1 except for when she fell back in October 2024. LPA Wesley has no pictures of any bruising to resident #1's body.

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

A copy of this report was given to 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: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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