198602099-2-15-2023-11-AS-MVAO-CQUTE4-20230413143920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602099
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:03:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
02/06/2023 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230206170502

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: 67	DATE:	02/15/2023
		UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Michalene Johnson		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident was scratched while in care
Staff do not keep the facility from bed bugs

INVESTIGATION FINDINGS:

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On 2/15/23 Licensing Program Analyst (LPA) Martessa Brown conducted an initial complaint investigation regarding the above listed allegations. LPA called before entering and spoke with Administrator Elenore Barrientos is free from Covid-19. LPA met with Michalene Johnson, the facility Assistant Administrator and the purpose of the visit was explained. LPA was later met by administrator.

During today’s visit, LPA Brown toured the physical plant. LPA obtained and reviewed the following documents: Staff and client roster, resident R1 move in record, emergency contact, most recent physician & Appraisal report, Emergency contact and incident report. LPA conducted interviews administrator and Staff S2-S5 and Residents R2-R7 and Witness W1.

The investigation revealed the following:
Regarding allegation #1: Resident was scratched while in care.
LIC 9099 is on the next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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 11-AS-20230206170502

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 02/15/2023

NARRATIVE

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It was alleged that staff scratched resident while in care. On 2/14/23, LPA conducted interview with W1, stated R1 did not have any scratches and could not disclose any staff names on the alleged abuser and stated hallucinates. On 2/15/23, LPA was unable to interview R1due to not being in the facility. LPA conducted interviews with R2-R7 regarding the above allegation. All residents stated they have not been physical abused by staff or have they witness any staff scratched residents while in care. Interviews conducted with Assistant Administrator and Staff S2-S5, all stated they have not physical abuse or scratched residents while in care and there has not been any complaints. LPA reviewed R1’s file and reports indicate resident has dementia and schizophrenia. Based on interviews conducted and file reviews the above allegation unsubstantiated.

Regarding allegation #2: Staff do not keep the facility from bed bugs.

It was alleged that facility has bed bugs. On 2/14/23, LPA conducted interview with W1, stated R1 did not have any reports of bugs on them. On 2/15/23, LPA toured facilities bedrooms and there was no indication of bed bugs. LPA was unable to interview R1due to not being in the facility. LPA conducted interviews with R2-R7 regarding the above allegation. All residents stated they have not seen any bed bugs in their bedrooms or had any concerns. Interviews conducted with Assistant Administrator and Staff S2-S5, all stated they have not seen any bed bugs and there has not been any complaints. Based on interviews conducted and observations the above allegation is unsubstantiated.

Based on interviews conducted and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Administrator, and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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