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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602152
Report Date: 05/04/2023
Date Signed: 05/24/2023 01:53:28 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
04/28/2023 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20230428111619
FACILITY NAME:SANTA FE HOME CARE IIFACILITY NUMBER:
198602152
ADMINISTRATOR:ASIS, VIRGINIAFACILITY TYPE:
740
ADDRESS:2255 SANTA FE AVENUETELEPHONE:
(424) 558-8285
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
05/04/2023
UNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:VIRGINIA ASISTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff physically assaulted resident while in care.
Facility has pests.
Staff did not meet resident's dental hygiene needs.
Staff did not provide residents healthy nutritious meals.
Staff did not follow resident's doctor's orders.
Staff did not ensure that resident was adequately dressed.
Staff mentally abused resident.
Staff made inappropriate comments in front of resident.
Staff did not adequately supervise residents.
Resident sustained multiples injuries while in care.

INVESTIGATION FINDINGS:
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***************This was amended in error. No changes were made.
On 5/4/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced subsequent complaint visit at this facility to obtain additional information and to deliver complaint findings. LPA was greeted by Caregiver Allen Gloriani and House Manager/Caregiver Lucy Dezell. Administrator Virginia Asis arrived later and joined the visit. LPA explained the purpose of the visit.

The investigation consists of the following: On 5/3/2023, LPA obtained copies of the facility roster for residents and staff. Interviews were conducted with three staff (S1-S3) and four residents (R2-R5). LPA was unable to obtain information from two residents (R6-R7) due R6’s medical condition and R7 is in the hospital. LPA obtained and reviewed R1's service records. A tour of the facility was conducted. On 5/4/2023, LPA interviewed one resident (R1) and one witness (W1) by telephone. However, LPA Montoya was unsuccessful in attempt to conduct telephone interview with one potential witnesss (W2).

Report continued in LIC 9099C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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-20230428111619
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: SANTA FE HOME CARE II
FACILITY NUMBER: 198602152
VISIT DATE: 05/04/2023
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Based on records review, Resident #1 (R1) was admitted to the facility on 12/4/2022 and left the facility on April 4, 2023. R1 is non-ambulatory and has a mild cognitive impairment. R1 has a special diet of low sodium and low sugar.

Regarding allegation: Staff physically assaulted resident while in care.

LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), all five residents (R1-R5) denied staff physically assaulted resident while in care. S1 stated there are no reported incidents that staff physical assaulted residents while in care. W1 stated W1 heard that it was alleged that R1 was physically assaulted but W1 did not witness the incident and does not have any proof for the allegation. LPA did not observe any signs of physical assault to any residents in care during investigation visits. . Based on gathered information, there is no sufficient evidence to prove that staff physically assaulted resident while in care.

Regarding allegation: Facility has pests.



It was reported that rats are coming out of the wood planks in the back patio. LPA Montoya conducted interviews with three staff (S1-S3), all five residents (R1-R5) and a witness (W1). Based on interviews conducted, all three staff (S1-S3), and all five residents (R1-R5) denied that facility has pests. S2 and R2 stated sometimes squirrels appear on the retaining wall of the facility but they have not observed any rats inside and outside the facility. W1 stated W1 has not witnessed that facility has pests as W1 has not been to the facility. LPA did not observe any pests in the facility during the complaint visits. Based on gathered information, there is no sufficient evidence to prove that facility has pests.

Regarding allegation: Staff did not meet resident's dental hygiene needs.

It was reported that staff failed to brush R1’s teeth for weeks. LPA Montoya conducted interviews with three staff (S1-S3), all five residents (R1-R5) and a witness (W1). Based on interviews conducted, all three staff (S1-S3), and all five residents (R1-R5) denied that staff did not meet resident's dental hygiene needs. W1 stated W1 cannot provide comment to this allegation because W1 did not check on R1’s teeth. LPA was not able to observe R1’s teeth because R1 was no longer residing at the facility during the investigation visits. Based on gathered information, there is no sufficient evidence to prove staff did not meet resident's dental hygiene needs.

REPORT CONTINUED IN LIC 9099C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20230428111619
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: SANTA FE HOME CARE II
FACILITY NUMBER: 198602152
VISIT DATE: 05/04/2023
NARRATIVE
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Regarding allegation: Staff did not provide residents healthy nutritious meals.

It was reported that staff serves poor quality of food and not nutritious meals like KFC chicken, 711 pizza, candy, and cups of noodles. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3) and all five residents (R1-R5) denied that staff did not provide residents healthy nutritious meals. S2 stated staff serve three hot meals per day. S2 stated staff serve a balanced diet which includes a combination of protein, vegetables, fruits, rice or potato, soup, salad or sandwiches. W1 stated W1 has not heard or observed that staff did not provide residents healthy nutritious meals. LPA observed a menu with a balanced diet and LPA observed during the complaint visit on 5/3/2023 that staff served stewed pork, rice, stir fried vegetable, salad and fruits. Based on gathered information, there is no sufficient evidence to prove that staff did not provide residents healthy nutritious meals.

Regarding allegation: Staff did not follow resident's doctor's orders.

During pre-investigation, Reporting Party (RP) was unable to explain the allegation that staff did not follow doctor’s orders. RP stated there is no known doctor’s order for R1 that RP can remember. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3) and all five residents (R1-R5) denied that staff did not follow resident's doctor's orders. R1-R5 stated they don’t have doctor’s orders that staff need to follow. W1 stated W1 is unsure if R1 has doctor’s order that staff failed to follow. S2 stated staff follow residents’ special diet based on their medical conditions. S2 stated some residents require low sugar and/or low salt. Based on LPA’s records review, R1’s medical assessment dated 12/27/2023 shows R1 has a special diet. Based on gathered information, there is no sufficient evidence to prove that staff did not follow resident's doctor's orders.

Regarding allegation: Staff did not ensure that resident was adequately dressed.

It was reported staff sent R1 to the hospital naked and a former resident was allowed walking around the facility naked. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), all five residents (R1-R5) and a witness (W1) denied that staff did not ensure that resident was adequately dressed. R1 denied that staff sent R1 to the hospital without clothes on. W1 stated R1 was properly dressed when R1 visited the doctor’s clinic on 4/6/2023. LPA observed during the complaint visits that all residents are properly dressed. Based on gathered information, there is no sufficient evidence to prove that staff did not ensure that resident was adequately dressed.

REPORT CONTINUED IN LIC 9099C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20230428111619
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: SANTA FE HOME CARE II
FACILITY NUMBER: 198602152
VISIT DATE: 05/04/2023
NARRATIVE
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Regarding allegation: Staff mentally abused resident.

It was reported that staff mentally abused resident. PA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), all five residents (R1-R5) and a witness (W1) denied that staff mentally abused resident. S1 stated there is no reported incident that staff mentally abused resident. LPA did not observe any staff mentally abusing resident during the investigation visits. Based on gathered information, there is no sufficient evidence to prove that staff mentally abused resident.

Regarding allegation: Staff made inappropriate comments in front of resident.

It was reported that staff (S2) yelled and told administrator that S2 does not want to take care of R1 and R1 heard S2’s statement. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), all five residents (R1-R5) and a witness (W1) denied that staff made inappropriate comments in front of resident. LPA did not observe any staff making inappropriate comments in front of resident during the investigation visits. Based on gathered information, there is no sufficient evidence to prove that staff made inappropriate comments in the front of resident.

Regarding allegation: Staff did not adequately supervise residents.

It was reported that large pieces of apples were logged in resident’s mouth and staff allowing resident to walk around the facility butt naked and making sexual gesture to staff. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), and all five residents (R1-R5) denied that staff did not adequately supervise residents. W1 stated W1 did not witness this alleged incident. LPA reviewed a photo of R1 showing R1's mouth was open and a small piece of food was on R1's mouth but it is unclear when and where this incident happened. Based on gathered information, there is no sufficient evidence to prove that staff did not adequately supervise residents.

REPORT CONTINUED IN LIC 9099C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20230428111619
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: SANTA FE HOME CARE II
FACILITY NUMBER: 198602152
VISIT DATE: 05/04/2023
NARRATIVE
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This page is amended to add the allegation below.

Regarding allegation: Resident sustained multiples injuries while in care.

It was reported that R1 had multiple large bruises, swelling on right arm, leg, and left foot while in care at this facility. The incident was reported to Torrance Police Department. LPA Montoya conducted interviews with three staff (S1-S3), five residents (R1-R5) and one witness (W1). Based on interviews conducted, all three staff (S1-S3), all five residents (R1-R5) denied that resident sustained multiples injuries while in care. W1 stated according to doctor’s notes dated 4/6/2023, it was noted that R1 had a bruise on right arm and R1 complained of pain on left foot, left knee and left elbow. W1 stated R1’s doctor indicates the bruises and pain are not serious injuries and the cause is unknown. LPA was not able to obtain information from the Torrance Police Department about R1’s injury. Based on gathered information, there is no sufficient evidence to prove that staff made inappropriate comments in the front of resident.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the above allegations are Unsubstantiated.

An exit interview was conducted with Administrator Virginia Asis and a copy of the report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5