198602608-7-13-2022-28-AS-RORN-CJ3M3W-20220908091545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:36:17 PM

Unsubstantiated

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
07/05/2022 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220705131522

FACILITY NAME:	GROVE AT CERRITOS, THE		FACILITY NUMBER:	198602608
ADMINISTRATOR:	SAHAR MOSALLA		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 122	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Sahar Mosalla; Operations Administrative Specialist		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Resident is being intimidated while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Sahar Mosalla and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) file and obtained copies of Physician's Report, Appraisal, and ID Emeregency Info Sheet. LPA also interviewed the Administrator, Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #11 (R11).

The investigation revealed the following: in regards to the allegation "resident is being intimidated while in care", it is alleged that there is a male staff member who intimidates residents by staring at them intensely while they are having dinner. The name of the alleged staff member is unknown. 5 out of 5 staff members interviewed denied the allegation. Staff members interviewed denied initimidating any of the residents at the facility or being aware of any other staff members who are intimidating the residents.

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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-20220705131522

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: 07/13/2022

NARRATIVE

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Staff members interviewed indicated that they will observe residents when eating in the dining room to ensure that they are eating or in case they need any sort of assistance, but not in an intimidating way. 10 out of 11 residents interviewed denied the allegation. 10 out of 11 residents interviewed indicated that they feel safe at the facility and are not aware of any staff members intimidating any residents. 10 out of 11 residents interviewed indicated feeling comfortable while eating in the dining room. LPA toured the facility and dining room and did not observe any staff members attempting to intimidate any resident during the visit. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of client files and facility file records, 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 held, and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

LIC9099 (FAS) - (06/04)

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