198602022-1-5-2024-11-AS-MVAO-CZBUUA-20240109145313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602022
Report Date: 01/05/2024
Date Signed: 01/05/2024 02:13:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2023 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231004104300

FACILITY NAME:	HALLDALE MANOR		FACILITY NUMBER:	198602022
ADMINISTRATOR:	BUSTOS, GLENDA		FACILITY TYPE:	740
ADDRESS:	23438 HALLDALE AVENUE		TELEPHONE:	(310) 533-7364
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	6	CENSUS: 6	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	Glenda Bustos		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff member is emotionally abusing residents in care.
Staff do not ensure that residents in care attend their doctor’s appointments.
Staff member is unable to communicate with residents due to language barrier.

INVESTIGATION FINDINGS:

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On 1/5/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent complaint visit to deliver the complaint findings. Upon arrival, LPA met with Glenda Bustos and explained the purpose of the visit.

The investigation consisted of the following: On 10/9/2023, LPA toured the inside and outside grounds of the facility. LPA Montoya interviewed 4 out of 5 residents and 3 on-duty staff. One resident was sleeping during the visit and LPA was unable to obtain statements from this resident. LPA requested and obtained copies of Staff roster, Resident roster, and all five residents' Physician's Reports and Appraisals/Needs and Services Plans and Admission Agreement.

Report continued in LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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 11-AS-20231004104300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HALLDALE MANOR	FACILITY NUMBER: 198602022
	VISIT DATE: 01/05/2024

NARRATIVE

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Investigations Revealed the following:

Allegation: Staff member is emotionally abusing residents in care.

It is alleged that Staff member is emotionally abusing residents in care. On 10/9/2023 from 10:30 am – 11:45 am, LPA Lourdes Montoya conducted interviews with staff and residents. LPA interviewed four out of five residents (R1-R4) and three out of three staff (S1-S3) present at the facility during the visit. Interviews with R1, R2 and R3 revealed no staff is emotionally abusing residents in care. Interview with three staff (S1-S3) revealed that no staff member is emotionally abusing residents in care. Based on records review and LPA’s observations, residents (R1, R2 and R4) are disoriented/confused due to their medical conditions. LPA did not observe residents fear any staff. LPA observed staff are calm, attentive, and respectful to residents in care. Based on information gathered during the investigation, there is no sufficient evidence to corroborate the allegation above.

Allegation: Staff do not ensure that residents in care attend their doctor’s appointments.

It is alleged that staff do not ensure that residents in care attend their doctor’s appointments. On 10/9/2023 from 10:30 am – 11:45 am, LPA Lourdes Montoya conducted interviews with staff and residents. LPA interviewed four out of five residents (R1-R4) and three out of three staff (S1-S3) present at the facility during the visit. Based on interviews conducted, all four residents (R1-R4) denied that staff do not ensure that residents in care attend their doctor’s appointments. Three staff (S1-S3) denied that staff do not ensure that residents in care attend their doctor’s appointments. S1, S2 and S3 stated three residents (R1, R3 & R4) have case workers who arrange their medical appointments. The case workers or facility staff take the residents to their medical appointments. S2 and S3 revealed during interviews that R1’s case worker set up an appointment for R1 in July but did not inform the facility. Neither the case worker nor the facility staff brought R1 to the appointment. R1’s medical appointment was rescheduled for August and S3 took R1 to the doctor. S2 and S3 stated they ensure that residents in care attend their doctor's appointments, but case workers should inform the facility. Based on information gathered during the investigation, there is no sufficient evidence to corroborate the allegation that staff do not ensure that residents in care attend their doctor’s appointments.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231004104300

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HALLDALE MANOR	FACILITY NUMBER: 198602022
	VISIT DATE: 01/05/2024

NARRATIVE

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Allegation: Staff member is unable to communicate with residents due to language barrier.

It is alleged that staff member is unable to communicate with residents due to language barrier. On 10/9/2023 from 10:30 am – 11:45 am, LPA Lourdes Montoya conducted interviews with staff and residents. LPA interviewed four out of five residents (R1-R4) and three out of three staff (S1-S3) present at the facility during the visit. Based on interviews conducted, two out of four interviewed residents (R2-R3) denied that staff member is unable to communicate with residents due to language barrier. Based on interviews conducted, three staff (S1-S3) denied that staff member is unable to communicate with residents due to language barrier. S1 stated R4 speaks Spanish. R3 speaks Spanish and English and sometimes R3 translates for R4. Staff also use online translators to communicate with R4 and they understand each other. Based on LPA’s observations and record review, R1 is disoriented/confused due to a medical condition. LPA observed R1 has difficulty maintaining a conversation. Based on information gathered during the investigation, there is no sufficient evidence to corroborate the allegation above.

Based on observations, records review and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Glenda Bustos and a copy of the report was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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