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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602099
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:47:46 PM

Substantiated


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
01/05/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240105143359
FACILITY NAME:CORAL OAKS CARE LIVINGFACILITY NUMBER:
198602099
ADMINISTRATOR:ELEANOR BARRIENTOSFACILITY TYPE:
740
ADDRESS:4271 CARLIN AVETELEPHONE:
(310) 763-4881
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:84CENSUS: 72DATE:
01/12/2024
UNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Ellen Barrientos, AdministratorTIME COMPLETED:
03:12 PM
ALLEGATION(S):
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Staff do not treat resident with dignity
INVESTIGATION FINDINGS:
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On 01/12/24 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit at the above-mentioned facility. LPA was met by Ellen Barrientos, Administrator (S1), and the purpose of the visit was explained.

The investigation consisted of the following:
On 01/11/24 LPA requested and reviewed facility documents which included admission agreements, safeguards of property and valuables, personnel report, resident census and LPA and S1 toured the facility. LPA interviewed seven (07) out of seventy-two (72) residents and four (04) out of twenty-eight (28) staff.
On 01/12/23 LPA further interviewed two (02) of the previously interviewed four (04) staff, conducted on 01/11/24. LPA also interviewed one (1) additional staff member and reviewed additional documents which included restricted/modified diets, kitchen weekly menus, daily notes related to sheriff's attendance and two (02) staff's training documents.
Report continues, see 9099C.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
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 5
Control Number 11-AS-20240105143359
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: CORAL OAKS CARE LIVING
FACILITY NUMBER: 198602099
VISIT DATE: 01/12/2024
NARRATIVE
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The investigation revealed the following:
Regarding the allegation: "Staff do not treat resident with dignity.". It has been alleged that multiple staff have made derogatory comments toward resident one (R1). On 01/11/23 LPA toured the facility and interviewed seven (07) out of seventy-two (72) residents. Six (06) out of seven (07) residents have denied the allegation and have not observed any derogatory comments from staff members. LPA interviewed four (04) out of twenty-eight (28) staff. Three (3) out of four (4) staff have denied the allegation and deny observing the allegation taking place, one (1) staff has agreed and admitted to the allegation.

According to LPA's observations, interviews and record reviews conducted, there is enough evidence to support the above allegation. The above allegation is valid as the preponderance of the evidence standard has been met. Therefore, the allegation has been Substantiated.

One deficiency has been cited, see LIC9099-D

An exit interview was conducted with Ellen Barrientos, Administrator (S1), and a copy of the report and appeals rights have been provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/05/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240105143359

FACILITY NAME:CORAL OAKS CARE LIVINGFACILITY NUMBER:
198602099
ADMINISTRATOR:ELEANOR BARRIENTOSFACILITY TYPE:
740
ADDRESS:4271 CARLIN AVETELEPHONE:
(310) 763-4881
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:84CENSUS: 72DATE:
01/12/2024
UNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Ellen Barrientos, AdministratorTIME COMPLETED:
03:12 PM
ALLEGATION(S):
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Staff do not safeguard resident’s personal belongings
Staff do not provide adequate food service to residents
INVESTIGATION FINDINGS:
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On 01/12/24 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit at the above-mentioned facility. LPA was met by Ellen Barrientos, Administrator (S1), and the purpose of the visit was explained.

The investigation consisted of the following:
On 01/11/24 LPA requested and reviewed facility documents which included admission agreements, safeguards of property and valuables, personnel report, resident census and LPA and S1 toured the facility. LPA interviewed seven (07) out of seventy-two (72) residents and four (04) out of twenty-eight (28) staff.
On 01/12/23 LPA further interviewed two (02) of the previously four (04) staff interviewed on 01/11/24 and reviewed additional documents which included restricted/modified diets, kitchen weekly menus, daily notes related to sheriff's attendance and two (02) staff's training documents.

Report continues, see 9099C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240105143359
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: CORAL OAKS CARE LIVING
FACILITY NUMBER: 198602099
VISIT DATE: 01/12/2024
NARRATIVE
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The investigation revealed the following:

Regarding the allegation: "Staff do not safeguard resident’s personal belongings.". It has been alleged that staff have not assisted a resident in locating their missing items. LPA interviewed 04 staff (S1-S4). All 04 staff have denied the allegation and have agreed that all staff assist residents with resolving these situations. LPA interviewed 07 residents (R1-R7). Six (06) out of 07 residents have denied the allegation.

Record reviews revealed that at 2:30PM, on 01/03/24, LA County Sheriff, Dewitt, had come out to the facility to investigate on the above allegation, which had occurred on 01/02/24. No charges were pressed, but above-mentioned facility has provided daily communication log that notes the subject of the complaint has the right to file charges against the complainant for going through the subject's drawers without permission.

Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation is found to be Unsubstantiated.

Regarding the allegation: "Staff do not provide adequate food service to residents.". It has been alleged that the facility serves foods that comes out of cans and that residents are not served any fresh vegetables. LPA interviewed 04 staff (S1-S4). All 04 staff have denied the allegation and have agreed that all staff conduct "stand-in" meetings two (2) to three (3) times per week to make sure all staff are aware of any change of diet or changes in condition. LPA interviewed 07 residents (R1-R7). Six (06) out of 07 residents have denied the allegation and agree that they are satisfied with the food choices being provided.

Record reviews revealed documents of modified diets were present, in the kitchen, for six (06) residents and restricted diets were present for four (04) residents. Also present were alternative food choices and a salad bar, for those residents who do not chose to take the scheduled meal.

Based on observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation is found to be Unsubstantiated.

LPA provided Technical Assistance Notes, see LIC9102AN.

An exit interview was conducted with Ellen Barrientos, Administrator, and a copy of this report has been provided.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240105143359
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: CORAL OAKS CARE LIVING
FACILITY NUMBER: 198602099
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/22/2024
Section Cited
CCR
87468.1(a)(1)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
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LPA and Administrator, Ellen Barriantos, have agreed that staff will undergo in-staff training to remain compliant under personal rights 87468.1, Title 22, regulations.
To confirm this regulation is met, staff will read CCR87468.1 (in a language they understand) and confirm their understanding
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This has not been met as evidenced by:
LPA's interview with one staff member, which has confirmed the fact that uncharacteristic comment(s) have been provided towards residents.
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and sign a group attendance confirmation which also shows their typed name. A personal confirmation page, also typed/signed, will be added to each staff's personnel file. The Facility will submit all paperwork (for all staff members), via email, to mario.leon@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5