198602870-2-25-2021-28-AS-MVAO-BZMNKS-20210331103224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602870
Report Date: 02/25/2021
Date Signed: 02/25/2021 02:44:30 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
09/30/2020 and conducted by Evaluator Tony Vasallo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200930160444

FACILITY NAME:	SERENTO CASA		FACILITY NUMBER:	198602870
ADMINISTRATOR:	KNEEDY-CAYEM, KARA		FACILITY TYPE:	741
ADDRESS:	1740 SAN DIMAS AVENUE		TELEPHONE:	(909) 394-0304
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	131	CENSUS: 50	DATE:	02/25/2021
		UNANNOUNCED	TIME BEGAN:	02:34 PM
MET WITH:	Kara Kneedy, administrator		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Facility charged resident for services not needed.
Facility failed to issue a refund.
Facility staff did not keep facility clean.
Facility staff mishandled resident's medication.
Facility staff spoke inappropriately to resident's family.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vasallo initiated a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Kara Kneedy, administrator. The initial complaint tele-visit was conducted on 10/7/21.

The investigation consisted of the following: Interviews were conducted with 6 staff and 5 residents. LPA also reviewed email correspondence between facility staff and Resident #1’s (R1) family along with R1’s care plan dated 3/15/20.

The investigation revealed the following: Allegation: Facility charged resident for services not needed. It’s alleged facility overcharged R1 for services not needed. Staff interviewed deny the allegation. Staff indicated R1 was assessed and a care plan was created. R1’s family agreed to the care plan and charges.
Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

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-20200930160444

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: SERENTO CASA	FACILITY NUMBER: 198602870
	VISIT DATE: 02/25/2021

NARRATIVE

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According to staff, months later R1’s family argued that R1 no longer needed all the services being charged. Facility agreed to refund R1’s family for the services, however indicated that R1 still required some assistance with Activities of Daily Living (ADL’s). R1 has since passed away and LPA cannot determine what ADL’s R1 needed assistance with. R1’s care plan was reviewed. The care plan indicates R1 needed assistance with medication management, chronic condition management, respiratory equipment, nebulizer treatments, nutrition, dressing/grooming, bathing, bathroom assistance, escort/mobility assistance, and 2-person transfer. The care plan is signed by R1’s family. Based on the information obtained the allegation is unsubstantiated.

Allegation: Facility failed to issue a refund. Facility staff indicated R1’s family received a refund that was agreed upon by the family and facility. R1’s family was interviewed and confirmed that they eventually received the refund amount agreed upon. Email correspondence reviewed also indicates the facility and R1’s family agreed on the amount of the refund. Therefore, this allegation is unsubstantiated.

Allegation: Facility staff did not keep facility clean. It’s alleged R1’s room was not kept clean and the facility dog would have accidents inside the facility. Staff interviewed deny the allegation. Staff indicate R1 would hoard food and would get upset when staff through the rotten food away. Residents interviewed deny the allegation. Residents reported liking the dog and indicated the facility is always clean. Facility has been virtually toured and appeared to be clean. This allegation is unsubstantiated.

Allegation: Facility staff mishandled resident's medication. It’s alleged R1’s medication fell in the hallway near where the facility dog had an accident and tried to give the medication to R1. Staff interviewed included the Medication Technician (Med Tech) that would assist R1 with medication. The Med Tech (Staff #1 S1) indicated that one time R1’s medication did fall on the floor in R1’s room when S1 was assisting with medication. S1 offered to get R1 another medication and R1 refused. Residents interviewed indicated they have not had any issues with their medications and did not have any complaints about staff. This allegation is unsubstantiated.

Allegation: Facility staff spoke inappropriately to resident's family. It’s alleged facility staff compared residents to dogs when referring to the facility dog having an accident inside the facility. Staff deny the allegation and indicate their words were misinterpreted. There were no other witnesses to the alleged incident. Residents interviewed were happy with facility staff and had no complaints. This allegation is unsubstantiated.

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.

An exit interview was conducted with Kara Kneedy, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021

LIC9099 (FAS) - (06/04)

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