198602864-5-27-2021-11-AS-JHAD-C4YNBD-20210716101859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602864
Report Date: 05/27/2021
Date Signed: 05/27/2021 06:02:45 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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2020 and conducted by Evaluator Martessa Brown

COMPLAINT CONTROL NUMBER: 11-AS-20201116140817

FACILITY NAME:	SENIOR MANOR CARE		FACILITY NUMBER:	198602864
ADMINISTRATOR:	GRADNEY, ANGELIQUE		FACILITY TYPE:	740
ADDRESS:	2011 SANTA RENA DRIVE		TELEPHONE:	(310) 989-1941
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6	CENSUS: 2	DATE:	05/27/2021
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Gloria Somintac, House Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was raped while in care.
Resident was touched inappropriately while in care.

INVESTIGATION FINDINGS:

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On 5/27/21 at 2:50 PM , Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent visit in order to render investigation findings for the above allegation. Today’s complaint investigation findings was conducted with Gloria Somintac , the facility House Manger and the purpose of the visit was explained.

The investigation consisted of the following: On 11/16/2020 LPA received a Personal Rights Allegation and Complaint was accepted and investigated by Jose Santana-Investigator. Licensing Program Analyst (LPA) Martessa Brown initiated the 10-day complaint visit on 11/17/20 and met with Gloria Somintac, the facility House Manager. LPA conducted a Health and Safety check and did the following: LPA’s toured the physical plant and requested residents and staff records. IB Investigator Jose Santana interviewed facility staff, residents and obtained a copy of the police report and records.

LIC 9099-C is on the next page:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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 11-AS-20201116140817

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SENIOR MANOR CARE	FACILITY NUMBER: 198602864
	VISIT DATE: 05/27/2021

NARRATIVE

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Regarding the allegations: Resident was raped while in care and Resident was touched inappropriately while in care.

On 11/20/20, Investigator interview Resident R1 at the hospital. She stated she was sexually assaulted by Staff S1 at the facility. R1 stated the abuse happened when S1 would change her on two separate occasions. R1 stated the Incidents had taken place in the morning but R1 could not remember the dates. R1 stated she told the social worker and was removed from the facility. On 11/23/20, Investigator interviewed Ombudsman, he stated he had spoken to R1 regarding the above allegations, but she stated she did not notify anyone at the facility and only text messaged her friend. On 11/24/20, Investigator interviewed R1’s friend. She stated would visit her twice a week and S1 was the primary caregiver in the daytime and would change and give R1 baths. She stated R1 told her about the allegation over text message and stated this occurred possibly 11/04/20 and 11/8/20. On 12/1/20 interviewed reporting party and she was notified of the allegation by hospice nurse on 11/13/21. she stated she went to the facility and conducted interviews with R1 and staff on 11/16/20 and staff denied these allegations. Hospice nurse stated on 11/13/20 while she was at the facility R1 reported the sexual abused happened while being changed. Interviewed House Manager, she stated S1 was a live-in caregiver who assisted changing R1 and was not alone. She stated R1 never disclosed any sexual abuse to her. Interview with S2 and she stated S1 would assist with changing R1. She stated R1 did not mention to her any sexual allegations. She stated S1 and R1 did not have a good relationship and would have altercations before this incident. Interview with business manager and she stated allegation may have been a result form from a prior altercation between R1 and S1 involving a tv. On 1/8/2021 interviews with S1 prior Administrator and 2 coworkers they stated there was a couple altercations with coworker but did not have problems with residents. On 2/4/21 interviewed S1 and he stated would only assist S2 with changing and did not clean up R1. He stated he was not alone with her and R1 is making up these allegations because she doesn’t like him.

Interview with detective stated DA’s office did not want to file charges due to insufficient evidence. Also, detective stated the case was closed.

Although the allegations are valid or may have happened there is insufficient evidence to support the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted and a copy of this report was provided to Gloria Somintac.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC9099 (FAS) - (06/04)

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