198602608-9-29-2022-28-AS-RORN-CK4SSU-20221011140832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:01:59 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
09/23/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220923154026

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:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Executive Director Lililit Chaparyan		TIME COMPLETED:	04:16 PM

ALLEGATION(S):

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Staff mismanaged resident's medication.
Staff does not prevent inappropriate interaction between residents.

INVESTIGATION FINDINGS:

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On 9/29/2022 at 10:17 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced
complaint investigation to the facility. Upon arrival LPA met with Lililit Chaparyan (Executive Director) and explained the purpose of the visit.

During today’s visit LPA toured the facility with the executive director and the wellness director (Staff #1), obtained resident/ staff roster, statement from Staff 4 regarding R1, R1’s physician’s orders dated 7/21/2021, 8/24/2021, and 9/29/2022. LPA interviewed residents R1 through R12. LPA Interviewed executive director, Staff S1, S2, and S3.

Report continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20220923154026

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: 09/29/2022

NARRATIVE

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The investigation reveals the following: Regarding " Staff mismanaged resident’s medication", it is alleged that the facility administered three medications to R1 but R1 only takes one medication. LPA reviewed R1’s current physicians orders and observed R1 only receive one medication. R1’s physicians orders dated 7/21/21 confirmed R1 was prescribed the two additional medications. R1’s physician’s orders dated 8/24/21 confirmed both medications were discontinued. The executive director confirmed R1 only receives one medication at this time. The executive director also stated on Saturday 9/24/22, R1 called campus police and reported the facility was over-medicating the resident. R1’s Physicians orders was given to campus police stating that the medications were discontinued. S4 submitted a statement to the facility describing the situation on 9/24/22. The wellness director (staff #1) confirmed R1 only received one medication and the other two medication was discontinued on 8/24/2021. S2 confirmed R1 only receives one medication and refuses when staff tries to administer R1’s medication. S1 also stated staff has always administered medications as prescribed. 7/12 residents stated they are independent and administers their own medications. They also stated they have never heard other residents complain about medication mismanagement. 4/12 residents stated staff assists with their medications, and they have no concerns about their medications. 1/12 residents stated that staff was over-medicating when administering medications.

The investigation reveals the following: Regarding "Staff does not prevent inappropriate interaction between residents", it is alleged that R2 is bothering R1. LPA interviewed R1 who stated that R2 made R1 feel uncomfortable and was asking to many questions trying to get to know R1 better. R1 stated that R2 also talks to other residents and tries to get to know them. R1 is unsure if it was reported to the facility. R2 stated there have never been any issues with R1 and that R1 is never in the facility. The executive director and 3/3 staff confirmed R2 has a conflicting personality with other residents but do not harass other residents. The executive director confirmed facility was unaware of R1’s problems with R2 and would have addressed it if known. 11/12 residents stated they have never seen inappropriate interactions between other residents, nor have they heard of other residents complaining about issues related to being harassed or uncomfortable at the facility.

Based on LPA's interviews, and file review the investigation revealed: 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.

Exit interview conducted with Lila Chaparyan and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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