197607718-11-22-2021-11-AS-AJKK-C98NFZ-20211129092622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 11/17/2021
Date Signed: 11/22/2021 10:28:27 AM

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/23/2020 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20201123090721

FACILITY NAME:	CENTINELA ASSISTED LIVING CENTRE		FACILITY NUMBER:	197607718
ADMINISTRATOR:	GWENDOLYN CRAIG		FACILITY TYPE:	740
ADDRESS:	1000 S FLOWER ST		TELEPHONE:	(310) 674-3216
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90301
CAPACITY:	96	CENSUS: 53	DATE:	11/17/2021
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Elizabeth Hernandez		TIME COMPLETED:	10:55 PM

ALLEGATION(S):

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Staff failed to provide adequate food service
Insufficient staff to meet the needs of the residents
Staff are unable to communicate with residents due to a language barrier
Staff mismanaged resident's medication.
Staff not responding to residents call button
Facility is unclean

INVESTIGATION FINDINGS:

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On 11/17/2021, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent unannounced complaint visit to deliver the complaint findings. LPA Montoya called the facility and spoke with Director of Social Services Elizabeth Hernandez to conduct a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. LPA Montoya met with Elizabeth Hernandez and explained the purpose of the visit.

The investigation consisted of the following: A tour of the facility on 12/2/2021 and 8/4/2021; interviews with the administrator, staff, and residents on 7/21/2021, 7/27/21 and 8/4/2021; and review of resident records on 7/27/2021 and 8/4/2021.

REPORT CONTINUED IN LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

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-20201123090721

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/17/2021

NARRATIVE

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The investigation revealed the following:

Based on record review, the Admission Agreement shows Resident #1, the alleged victim, was admitted to the facility on February 4, 2020. According to Appraisal/Needs and services plan dated 2/11/2020, Resident #1 refused to review and participate in the appraisal.

Allegation: Staff failed to provide adequate food service

It is alleged that Staff failed to provide adequate food service.

The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Residents (#2-#10) were available for interview; two (2) Residents (#11 and #12) refused to be interviewed.

The department’s interview revealed out of nine (9) interviewed residents, eight (8) Residents (#2, #3, #4, $5, #6, #7, #8 and #10) are satisfied with the facility’s food service. Only one (1) Resident (#9) stated food service is not good. Staff #1 and #2 disclosed there is only one resident who keeps complaining about the facility’s food service, but this resident does not take or eat the food provided by the facility. Staff #3, the kitchen supervisor, explained sometimes residents make special requests and the kitchen staff always try to accommodate all residents and ensure the food services are beyond satisfactory. Staff #4-6 reported they have not heard complaints from resident about the facility’s food service. Per department’s review, it is noted in the facility’s Resident Dining Details Report that Resident #5, who stated in the interview the food service is bad, has food allergies and supplements/food preferences. This report was created and maintained to meet the residents’ special needs and requests, according to the Dietary Supervisor (Staff #3). The department also observed in the facility’s Summer Menus that the facility maintains a daily diet of quality and quantity necessary to meet the needs of the residents. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned above.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201123090721

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/17/2021

NARRATIVE

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Allegation: Insufficient staff to meet the needs of the residents

It is alleged the facility has insufficient staff to meet the needs of the residents. The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Nine Residents (#2-#10) were available for interview; two Residents (#11 and #12) refused to be interviewed.

interview with nine residents (#2-#10) revealed the facility has sufficient staff to meet their needs. Staff #1-#6 stated there is sufficient staff in all shifts to meet the needs of the residents. Review of the Personnel Report indicated the facility has three work shifts and there is sufficient staff to meet the needs of the residents. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff are unable to communicate with residents due to a language barrier

It is alleged staff are unable to communicate with residents due to a language barrier. The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Nine Residents (#2-#10) were available for interview; two Residents (#11 and #12) refused to be interviewed.

The department’s interview revealed Residents #2-#8 are able to communicate with residents without a language barrier. Residents #9 and #10 claimed caregivers are unable to communicate well with them because the caregivers only speak Spanish. Staff #1-#6 stated they communicate well with residents. The department’s interview with Staff #1-#6 revealed they communicate well, and no language barrier was observed. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned above.

REPORT CONTINUED IN LIC 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20201123090721

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/17/2021

NARRATIVE

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Allegation: Staff mismanaged resident's medication.

It is alleged staff mismanaged resident’s medication. The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Nine Residents (#2-#10) were available for interview; two Residents (#11 and #12) refused to be interviewed.

Residents (#2-#10) revealed in interviews that staff did not mismanage their medications. Staff (#1-#2) stated they did not receive a complaint regarding mismanagement of resident’s medication. Staff (#3) refused to make comments regarding this allegation. Staff (#4-#6) revealed in interview that no residents are having problems receiving their medications. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff not responding to residents call button

It is alleged the Staff not responding to residents call button. The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Nine Residents (#2-#10) were available for interview; two Residents (#11 and #12) refused to be interviewed.

The department’s interview revealed Residents (#2, #3, #5, and #7) do not use the call button in their bedroom. They said they prefer to go to the front desk for assistance. Residents (#6 and #8) stated facility staff respond quickly when they use the call button for assistance. Resident (#4), whose bedroom is #6A, reported the call button in the bedroom is inoperable. Resident #9 reported he does not have a call button in his bedroom. Resident (#10) stated the call button in her bedroom (# 35B) does not work. Staff #1 mentioned the dashboard of residents’ call buttons

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20201123090721

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/17/2021

NARRATIVE

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is located in the office/front desk and staff respond quickly to residents’ calls. Staff (#1) also reported the call buttons in bedrooms #1, #35 and #38 are not operable. Staff #2 reported staff respond quickly to residents’ calls unless but there are call buttons that are not working. Staff #3 refused to make comments regarding this allegation. During the department’s tour of the facility on 7/21/2021, it was observed that some bedrooms have broken call buttons but residents whose call buttons are operable stated staff respond quickly to their calls. Based on LPA’s record review, the facility has an ongoing repair plan of the broken call buttons. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned

Allegation: Facility is unclean

It is alleged that the facility is unclean The department attempted to interview Residents (#1-#11); Resident #1 was not available for interview because he was out of the facility; Nine Residents (#2-#10) were available for interview; two Residents (#11 and #12) refused to be interviewed.

All nine interviewed resident (#2-#10) revealed the facility is clean. Staff #1 and #2 stated they did not receive a complaint regarding this allegation. Staff #3 refused to make comments regarding this allegation. Staff (#4-#6) stated the facility is clean every day. Based on LPA’s observations, interviews, and records review, LPA did not find sufficient evidence to support the allegation mentioned

Based on information gathered, LPA did not find sufficient evidence to support the allegations, “Staff failed to provide adequate food service”, “Insufficient staff to meet the needs of the residents”, “Staff are unable to communicate with residents due to a language barrier”, “Staff mismanaged resident's medication”, “Staff not responding to residents call button”,

REPORT CONTINUED IN LIC 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20201123090721

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
MONTERY PARK, CA 91754

FACILITY NAME: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 11/17/2021

NARRATIVE

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and “Facilityis unclean”. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A hard copy of the report was provided to Elizabeth Hernandez.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021

LIC9099 (FAS) - (06/04)

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