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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 06/07/2022
Date Signed: 06/07/2022 11:06:55 AM

Unsubstantiated


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
06/01/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220601141229
FACILITY NAME:GARDENA RETIREMENT CENTERFACILITY NUMBER:
197607366
ADMINISTRATOR:SUSANA FUENTESFACILITY TYPE:
740
ADDRESS:14741 S. VERMONT AVE.TELEPHONE:
(310) 327-4091
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY:108CENSUS: 67DATE:
06/07/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:SUSANA FUENTESTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Facility illegally evicted resident.
Facility retaliated against resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility on 06/07/2022 at around 09:00 AM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10 day visit on 06/07/2022 approximately around 09:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 06/03/2022 LPA Calderon interviewed W1 for complaint. On 06/07/2022 LPA Calderon requested copies of the following: Staff and Resident rosters, admission agreement for W1, last filed 30-day eviction notice, court eviction paperwork for W1. On 06/07/2022 LPA Calderon interviewed S2 – S3 for complaint.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
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 3
Control Number 11-AS-20220601141229
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: GARDENA RETIREMENT CENTER
FACILITY NUMBER: 197607366
VISIT DATE: 06/07/2022
NARRATIVE
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Regarding Allegation #1: Facility illegally evicted resident.

On 06/03/2022 LPA Calderon interviewed W1 for complaint. W1 states that W1 was served 30-day notice of eviction which W1 ignored. W1 states W1 was served court paperwork for W1 eviction and W1 went to court. W1 states that 3 staff members testified against W1 claiming W1 violated house rules and failed to pay W1 rent and this was the reason why W1 was being evicted. W1 states that there was no way to fight the court and W1 settled with the facility. W1 states that the judge ordered a 30-day eviction process and that W1 had to be out of the facility by 06/02/2022. W1 states that W1 moved out as the court ordered. On 06/07/2022 LPA Calderon interviewed S1 – S3 regarding the complaint all state that they were asked to testify in court regarding the eviction of W1 and the judge ordered W1 to leave the facility no later than 06/02/2022 or be arrested. Per S1 -S3 information there was no mention of the facility staff retaliating towards W1 in court and W1 never brought up any issues with staff or the facility. On 06/07/2022 LPA Calderon received and reviewed superior court paperwork for eviction of W1. Date court paperwork was served 03/09/2022. Court judgement was found against W1 and W1 was given 30 days to leave the facility as of 06/01/2022. W1 did not testify or present any proof of a in proper eviction or any proof of retaliation by staff or the facility due to W1 making complaints.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20220601141229
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: GARDENA RETIREMENT CENTER
FACILITY NUMBER: 197607366
VISIT DATE: 06/07/2022
NARRATIVE
1
2
3
4
5
6
7
8
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11
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Regarding Allegation #2: Facility retaliated against resident.

On 06/03/2022 LPA Calderon interviewed W1 for complaint. W1 states that W1 was served 30-day notice of eviction which W1 ignored. W1 states W1 was served court paperwork for W1 eviction and W1 went to court. W1 states that 3 staff members testified against W1 claiming W1 violated house rules and failed to pay W1 rent and this was the reason why W1 was being evicted. W1 states that there was no way to fight the court and W1 settled with the facility. W1 states that the judge ordered a 30-day eviction process and that W1 had to be out of the facility by 06/02/2022. W1 states that W1 moved out as the court ordered. W1 states that W1 has filed many complaints since the facility is making decisions that is against the rights of the residents, but no one will call the administrator out and W1 states that W1 must call out the facility and therefore the facility evicted W1 from the facility. On 06/07/2022 LPA Calderon interviewed S1 – S3 regarding the complaint all state that they were asked to testify in court regarding the eviction of W1 and the judge ordered W1 to leave the facility no later than 06/02/2022 or be arrested. Per S1 -S3 information there was no mention of the facility staff retaliating towards W1 in court and W1 never brought up any issues with staff or the facility. On 06/07/2022 LPA Calderon received and reviewed superior court paperwork for eviction of W1. Date court paperwork was served 03/09/2022. Court judgement was found against W1 and W1 was given 30 days to leave the facility as of 06/01/2022. W1 did not testify or present any proof of a in proper eviction or any proof of retaliation by staff or the facility due to W1 making complaints.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of Facility illegally evicted resident., Facility retaliated against resident. is found to be UNSUBSTANTIATED.



An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Susana Fuentes
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3