<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603118
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:56:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
07/09/2024 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20240709155106
FACILITY NAME:CLEARWATER AT SOUTH BAYFACILITY NUMBER:
198603118
ADMINISTRATOR:JILL TUCKERFACILITY TYPE:
740
ADDRESS:3210 & 3212 W SEPULVEDA BLVDTELEPHONE:
(424) 488-6340
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:137CENSUS: 116DATE:
07/17/2024
UNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Raul PereiraTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility HVAC is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/17/24, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced complaint visit to the facility listed above. LPA met with Assistant Executive Director, Cecille Bernabe, and Business Office Director, Raul Pereira, and the purpose of today’s visit was explained.

During today’s visit LPA toured the facility, took room temperatures, interviewed Staff S1-S8, interviewed residents R1-R10, and received documents pertinent to the investigation. LPA received and reviewed the following documents, Staff Roster, Resident Roster, Work Orders, and invoices from AC company.

The investigation revealed the following:


Continued On LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 11-AS-20240709155106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CLEARWATER AT SOUTH BAY
FACILITY NUMBER: 198603118
VISIT DATE: 07/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: The facility HVAC is in disrepair
The allegation alleges that the facility has had a broken air conditioning and heating system for about two (2) years.
During the facility tour, LPA used a thermometer to measure the temperature in common rooms and resident rooms. In common rooms, in both buildings, LPA observed the thermostats were set between 72-degrees and 78-degrees Fahrenheit, and the temperatures measured 74.3-degrees in the game room, 74.8-degrees in the facility entry, 73.2-degrees in the activity room, 76.7-degrees in the dining room, 77.3-degrees in the lounge area, 75.3-degree in the 1st floor activity room, 70.6-degrees in the 2nd floor multipurpose room, and 74.0-degrees in the 3rd floor multipurpose room. In the resident rooms inspected, LPA observed each room had their own thermostat for residents to control the temperature in their rooms and to set it at the temperature of their choice. The following rooms were inspected, temperatures recorded, and thermostats checked, room 104 measured 74.4-degrees and thermostat set at 74-degrees, room 107 measured 71.9-degrees and thermostat set at 72-degrees, room 112 measured 74.3-degrees and thermostat set at 75-degrees, room 117 measured 71.4-degrees and thermostat set at 72-degrees, room 124 measured 76.6-degrees and thermostat set at 76-degrees, room 203 measured 77.5- degrees and thermostat set at 78-degrees, room 205 measured 75.3 and thermostat set at 74-degrees, room 212 measured 72.2-degrees and thermostat set at 72-degrees, room 221 measured 77-degrees and the thermostat set at 76-degrees, room 224 measured 74.3-degrees and

Continued on LIC-9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20240709155106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CLEARWATER AT SOUTH BAY
FACILITY NUMBER: 198603118
VISIT DATE: 07/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
thermostat set at 74-degrees, room 229 measured 74.3-degrees and thermostat set at 73-degrees, and room 235 measured 78.6 and thermostat set at 77-degrees.
During record review, LPA received and reviewed an invoice from Providence Consulting & Design, LLC for air conditioning maintenance, dated on 05/13/24. Additionally, LPA received and reviewed the facility’s Work Orders from 05/01/24 to present and observed there were twenty-one (21) work orders regarding the air conditioning, and 10 of the work orders were a request to adjust the thermostat for the room being either hot or cold. During an interview with S3 and S4 stated that some of the residents do not know how to adjust the thermostat and have complained in the past about it either being too hot or too cold or the thermostat not working.
During interviews with Staff S1-S8, were asked if the air conditioning works in both buildings, eight (8) out of eight (8) stated the air conditioning works in all rooms. During interviews with S3 and S4, stated maintenance was conducted on the HVAC system on 05/13/24, and some of the rooms AC did not work during the maintenance but residents were provided with a portable air conditioner and fans. Additionally, S3 and S4 stated the main air conditioning units were replaced almost 2 years ago. During interviews with Staff S6-S8, stated the HVAC system is serviced twice a year, right before summer and right before winter. LPA asked Staff S2-S8 if they have received any complaints regarding the air conditioning, seven (7) out of seven (7), stated there have been complaints of resident rooms either being too hot or too cold and when the room is checked there are many instances that the resident has had difficulties operating the thermostat.
Continued on LIC9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240709155106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CLEARWATER AT SOUTH BAY
FACILITY NUMBER: 198603118
VISIT DATE: 07/17/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During interviews with Residents R1-R10, were asked if there have been any issues with their air conditioning in their rooms, eight (8) out of ten (10) stated there have been no issues with their air conditioning. Resident R1 stated their thermostat is broken and doesn’t work. LPA went to the resident’s room and tested the thermostat which worked properly and was set at 73, and the room temperature measured 71.6-degrees F. R9 stated the AC unit can use some work because it gets too cold, and their medication makes them cold, so it is really cold. Additionally, during interviews with Residents R1-R10, were asked if the common rooms were kept at a comfortable temperature, ten (10) out of ten (10) stated common rooms are kept at a comfortable temperature.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

LPA did not observe or cite any deficiencies.

An exit interview was conducted with Assistant Executive Director, Cecille Bernabe, and Business Office Director, Raul Pereira and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4