198602162-12-22-2023-11-AS-MVAO-CZ4VQN-20240102153838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602162
Report Date: 12/22/2023
Date Signed: 12/22/2023 12:18:57 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
12/19/2023 and conducted by Evaluator Lourdes Montoya

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231219134346

FACILITY NAME:	SANTA FE HOME CARE III		FACILITY NUMBER:	198602162
ADMINISTRATOR:	ASIS, VIRGINIA		FACILITY TYPE:	740
ADDRESS:	23223 PRYOR PLACE		TELEPHONE:	(310) 989-1941
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	6	CENSUS: 3	DATE:	12/22/2023
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Virginia Asis		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Resident’s personal belongings are missing.

INVESTIGATION FINDINGS:

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On 12/22/2023, LPA Lourdes Montoya conducted a subsequent complaint visit at this facility to deliver the complaint findings of the above allegation. LPA met with Administrator Virginia Asis. LPA explained the purpose of today's visit.

The investigations consisted of the following: On 12/21/2023, LPA toured the facility with Office Staff Rodolfo Lozada. LPA requested staff roster & resident roster, R1's service records and other pertinent records. LPA conducted interviews with three staff and two residents at the facility. One resident was sleeping and LPA was unable to obtain a statement. On 12/22/2023, LPA conducted a phone interview with one staff.

REPORT CONTINUED IN LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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-20231219134346

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: SANTA FE HOME CARE III	FACILITY NUMBER: 198602162
	VISIT DATE: 12/22/2023

NARRATIVE

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Investigations Revealed the following:

Allegation: Resident’s personal belongings are missing.

Soc 341 indicates “The resident used to live at the facility, and approximately a month and a half ago resident moved out. Resident’s personal belongings are still at the facility. Multiple times the resident asked the facility about it, but they said they don’t have it. The resident believes the facility staff stole the resident’s personal belongings.

It is alleged that resident’s personal belongings are missing. On 12/21/2023 at 1:00 pm – 3:00 pm, LPA Lourdes Montoya conducted interviews with staff and residents. LPA conducted a phone interview with one staff (S1), two staff (S2-S3) and two residents (R2-R3) at the facility. On 12/22/2023 at around 8:55 am, LPA conducted a phone interview with one former staff (S4). Interviews with two staff (S1-S2) revealed the facility was fumigated on March 2, 2023 and was reopened in April 29, 2023. R1 was transferred temporarily to another facility due to the temporary closure of the facility but R1 did not return to the facility. Interview with R1 revealed R1 left some shirts, blue jeans, shoes and other miscellaneous items at Santa Fe Home Care III and has not recovered them. Three staff (S1, S2 and S4) stated staff packed all R1’s personal belongings and were brought to the facility where R1 moved to. S1 and S2 stated they searched the facility for R1's belongings and brought some clothing and shoes to R1 but R1 denied they belonged to him. S1, S2 and S3 revealed R1 has been residing at the facility for a very long time and R1’s current personal belongings are not recorded and therefore it is unclear what specific items R1 are missing. S3 claimed S3 has no knowledge of R1’s personal belongings. LPA observed the facility did not maintain an inventory list to safeguard R1's personal property but it is unclear that R1 had lost personal belongings.

Based on the records review and interviews conducted, the Department did not find enough evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

Deficiencies were cited during this visit.

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

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