198602608-1-4-2023-28-AS-RORN-D29R6Q-20240208114504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 12/20/2022
Date Signed: 01/04/2023 12:20:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220623080038

FACILITY NAME:	GROVE AT CERRITOS, THE		FACILITY NUMBER:	198602608
ADMINISTRATOR:	BRITTNEY BUCHANNAN		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 126	DATE:	12/20/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lilit Chaparyan		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility staff did not dispense correct medications to resident
Facility staff did not provide care to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint visit to investigate the above allegations and LPA met with Receptionist Teresa Picos and explained the reason of the visit. Shortly after, LPA met with Business Office Manger Carment Hernandez and Executive Director Lilit Chaparyan and assisted with the visit.

The investigation consisted of the following: On 6/28/22, LPA Sicairos obtained copies of Staff & Resident Rosters. LPA reviewed Former Resident #1 (FR1) file and obtained copies of Identification and Emergency Information Sheet, Physician's Report, Admission Agreement, Service Plan, Progress Notes, Resident Appraisal, Admission Orders, and Resident Detail Ledger. LPA interviewed Ms. Mosalla and Staff #1 (S1). On today's visit, LPA Wong interviewed the administrator, 4 staff (S1-S4) and 13 residents (R2-R14) and obtained current staff roster and resident roster.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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 28-AS-20220623080038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GROVE AT CERRITOS, THE	FACILITY NUMBER: 198602608
	VISIT DATE: 12/20/2022

NARRATIVE

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The investigation revealed of the following: In regards to the allegation of "Facility staff did not dispense correct medications to resident" LPA interviewed 13 residents and all denied the allegation. All reported the staff dispensed the medication to them on time and with corrected medication. They have no issues or complaints about the medication in the facility. LPA also reviewed 6 residents' medication in the medication room and all the medication are managed correctly and properly.

In regards to the allegation of "Facility staff did not provide care to resident" LPA interviewed 13 residents and 9 out of 13 residents denied the allegation and reported they are happy and satisfied with the care that provided from the facility. All staff are nice to them and they have no complaints or concerns about the facility. LPA interviewed staff and they also stated that they never got any complaints from residents about the care that they provided to the residents. They usually tried to accommodate each residents needs. Each resident has their own schedule for showering or toileting. The staff would check on the residents regularly and ensure they are dry and comfortable.

Based on statements and interviews conducted with staff, residents, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit Interview Conducted but due to technical difficulties, LPA Wong was not able to print the complaint report and LPA will email the complaint report to Executive Director.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC9099 (FAS) - (06/04)

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