198602608-8-19-2021-28-AS-MVAO-C9XTCU-20211222133718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:05:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/20/2020 and conducted by Evaluator Nina Galarza

COMPLAINT CONTROL NUMBER: 28-AS-20201120110514

FACILITY NAME:	GROVE AT CERRITOS, THE		FACILITY NUMBER:	198602608
ADMINISTRATOR:	CRENSHAW, CAMILLE		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 117	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Brittney Buchannan		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Food services are inadequate.

INVESTIGATION FINDINGS:

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On 8/19/2021 Licensing Program Analysts (LPAs) Nina Galarza and Nune Margaryan conducted a subsequent complaint visit for the allegation listed above, initially reported on 11/20/2020. LPAs met with administrator Brittney Buchannan and stated the purpose of the visit.

The investigation consisted of interviews with Staff 1, (S1), Staff 2 (S2), Staff 3 (S3), Residents 1-11 (R1-R11). On 8/11/2021 LPAs interviewed S1. S1 stated all residents recieve breakfast, lunch and dinner. S1 stated each resident is given a starch, protein and vegetable with all meals. S1 stated if resident wanted more food, the resident would be provided more food. On 8/19/2021 LPAs interviews S2 and S3. S2 denied knowledge of residents complaining about the food service. S2 stated if residents want more food, the resident will be provided with more food. S2 stated during the pandemic, March 2020, all residents were served food in their rooms. S2 stated during the pandemic, March 2020, residents with diabetes were provided with their meal first, before other residents. S2 stated all residents are provided Breakfast, Lunch and Dinner. S2 stated during the pandemic, March 2020, after dinner service ended and the kitchen was closed, kitchen staff would leave extra food with the front recptionist, so if a resident wanted food, they would be provided with food. S3 denied knowledge of residents complaining about the food service. S3 stated during the pandemic, March 2020, residents were served food in their room. At 10:30 a.m. LPAs toured kitchen and food supply. Food supply was sufficent for 2 days perishable and 7 day nonperishable for all residents.

CONTINUED 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Nina Galarza	TELEPHONE: 323-981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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-20201120110514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GROVE AT CERRITOS, THE	FACILITY NUMBER: 198602608
	VISIT DATE: 08/19/2021

NARRATIVE

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On 8/11/2021, LPAs interviewed R1-R6, R 1-6 stated the food service is adequate. R1-R6 stated they are provided with 3 meals a day. R1-R6 stated they are given a menu with different options to chose from. R1-R6 stated the portions are sufficient. R 1-6 stated if they wanted more food, they would be provided with more food.

On 8/19/2021 LPAs interviewed R7-R11. R7-R11 stated the food service is adequate R7-11 stated they are provided with 3 meals a day. R7-R11 stated they are given a menu with different options to chose from. R7-R11stated the portions are sufficient. R 7-R11 stated if they wanted more food, they would be provided with more food.

LPAs were provided with a staff roster, resident roster and resident menu.

The investigation revealed of the following: "food service is inadequate". On 8/11/2021 LPAs interviewed Residents 1-6. (6) out of (6) Residents stated food service is adequate. On 8/19/2021, LPAs interviewed Residents 7-11. (5) out of (5) Residents stated the food service is adequate.

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 allegation is UNSUBSTANTIATED.

An exit interview was conducted, a copy of the report and appeal rights were provided to Maria Dolores Go.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Nina Galarza	TELEPHONE: 323-981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

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