198603118-8-3-2021-11-AS-MVAO-C8VPWQ-20211118104106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603118
Report Date: 07/20/2021
Date Signed: 08/03/2021 02:42:39 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
04/06/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210406110111

FACILITY NAME:	CLEARWATER AT SOUTH BAY		FACILITY NUMBER:	198603118
ADMINISTRATOR:	MICHAEL KRIEGER		FACILITY TYPE:	740
ADDRESS:	3210 & 3212 W SEPULVEDA BLVD		TELEPHONE:	(424) 488-6340
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	137	CENSUS: 83	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Ana Cardona		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident care needs are not being met

INVESTIGATION FINDINGS:

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On 07/20/2021 Licensing Program Analyst (LPA) Don Senaha conducted a subsequent visit to complete more interviews and deliver complaint findings. LPA met with Business Office Director Ana Cardona and explained the purpose of the visit.

On 04/13/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this complaint investigation was conducted via facetime tele-visit with Administrator Michael Krieger.

On 07/16/2021 Licensing Program Analyst (LPA) Don Senaha conducted a subsequent complaint investigation visit for the allegation listed above. This complaint investigation was conducted with Business Office Director Ana Cardona and Health Services Director Jamie Pyles.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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-20210406110111

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: CLEARWATER AT SOUTH BAY	FACILITY NUMBER: 198603118
	VISIT DATE: 07/20/2021

NARRATIVE

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The investigation consisted of the following: Interviews with Business Office Director Ana Cardona, Health Services Director Jamie Pyles, staff (S3-S7) and residents (R1-R10). LPA obtained client roster, staff roster, daily menus for March and April, Alternate Menu, records review for R1 and R9, Assisted Living shower schedule and end of shift reports for March and April. A plant inspection was conducted of the facility on 04/13/2021.

The investigation revealed:

Allegation: Resident care needs are not being met.

LPA conducted interviews with residents (R1-R10). Residents (R1-R10) stated they have no issues with their needs being met. Residents (R1-R10) stated they get help in a timely manner when they call for help from staff. Residents (R1, R3, R9) had no issues with shower service. Residents (R1-R10) stated they receive three meals breakfast, lunch and dinner per day and have an alternate menu should they not want to eat what is on the daily menu.

Staff (S1-S7) stated they met all the residents needs during their shifts. Staff (S1-S7) have no issues responding to residents in a timely manner and residents have a pendant to push for immediate help. Staff (S1-S7) follow the weekly shower schedule for each resident during their shift. Staff (S1-S7) stated all residents are entitled to breakfast, lunch and dinner and have a choice of an alternate menu each meal. Staff (S1, S3-S5) stated they discard medication needles immediately after use.

Based on the interviews conducted, observation and records reviews, LPA was unable to find evidence to support the allegation.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. 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 Ana Cardona and a hard copy was provided for signature.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC9099 (FAS) - (06/04)

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