198602099-1-11-2024-11-AS-EMAZ-D2FVB4-20240214151655

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602099
Report Date: 01/11/2024
Date Signed: 01/11/2024 04:49:14 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20240104172800

FACILITY NAME:	CORAL OAKS CARE LIVING		FACILITY NUMBER:	198602099
ADMINISTRATOR:	ELEANOR BARRIENTOS		FACILITY TYPE:	740
ADDRESS:	4271 CARLIN AVE		TELEPHONE:	(310) 763-4881
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	84	CENSUS: 72	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Eleanor Barrientos		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not prevent resident from physically assaulting another resident

INVESTIGATION FINDINGS:

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On 01/11/24, Licensing Program Analysts (LPA), Wendy Gibbs, conducted a complaint investigtion at the facility listed above. LPA met with Administrator, Elanore Barrientos, and Assistant Administrator, Michalene Johnson, and the purpose of today's visit was explained.

During today's visit, LPA toured the facility, received documents pertinent to the investigation, interviewed staff (S1-S5), and interviewed residents (R1-R7).

The following documents were received and reviewed: Staff Roster, Resident Roster, Resident's Physician's Report, Preplacement Appraisal Information, Appraisal/Needs and Services Plan, Special Incident Reports, Daily Communication Log, Nurse's Notes, Administrator Notes, and Hospital Discharge Papers.

The investigation revealed the following:
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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-20240104172800

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 01/11/2024

NARRATIVE

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Allegation:Staff did not prevent resident from physically assaulting another resident
The allegation alleges that Resident R1 was hit on the head multiple times by Resident R2.
During interviews with Residents (R1-R7), six (6) out of seven (7) stated they have not been hit or felt threatened by any of the other residents. R1 stated that they were hit on the head by R2 and they scratched R1's arm. During interviews with R2, they stated they did not hit R1 on the head and R1 did not hit them, and that neither of them hit each other. R2 further stated that there was an incident with R1 accusing R2 of taking R1's property and when R1 was opening R2's dresser drawer, R2 grabbed R1's arm, and when R1 pulled their arm away from R2's grip R1 got scratched. During interviews with staff (S1-S3) three out of three stated that when the incident between R1 and R2 had calmed down, staff stated they checked R2's drawers for R1's belongings and they did not find anything. During interviews with Staff (S1-S3) and Residents (R1 and R2) five (5) out of five (5) stated the Sheriffs were called and no charges were pressed because R2 was protecting their property from R1 and that if R1 pressed charges then charges would be brought on R1 as well. During interviews with staff (S1-S5) five (5) out of five (5) stated R1 has accused staff and other residents of taking their belongings. Additionally, they stated R1 has moved rooms 4 times due to accusing roommates of stealing R1s belongings and for going through other residents (R5) belongings and throwing their belongings into the trash. Upon document review, LPA observed that R1 has a history of going through other resident’s belongings .

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were observed or cited during today’s visit.

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

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

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