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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607366
Report Date: 08/28/2025
Date Signed: 08/28/2025 08:55:03 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2025 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20250820134633
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: 81DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
08:04 AM
MET WITH:Christina NovoaTIME COMPLETED:
09:05 AM
ALLEGATION(S):
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Staff unlawfully evicted a resident.
INVESTIGATION FINDINGS:
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This report supersedes the previous reports LIC9099, LIC9099-C, and LIC9099-D created on 08/25/2025, The findings regarding the complaint remain unchanged. On 08/28/2025, LPA Richard conducted a subsequent visit and met with Staff Christina Novoa, and explained the purpose of this visit. On 08/25/2025, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint investigation at the above facility to address the following allegation. LPA met with the Administrator Susie Fuentes and explained the purpose of the visit.

The investigation consisted of the following: On 08/22/2025, at proximately 12:30 PM, LPA Richard interviewed the Hospital Social Worker (SW). On 08/25/2025 at proximately 9:00 AM, LPA interviewed the Administrator (A1). LPA Richard also reviewed and obtained records for resident #1 (R1). LPA reviewed and obtained the Hospital Psychiatrist Progress Note (dated 08/22/2025).

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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-20250820134633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GARDENA RETIREMENT CENTER
FACILITY NUMBER: 197607366
VISIT DATE: 08/28/2025
NARRATIVE
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Allegation #1: Staff unlawfully evicted a resident.

The complaint states that the patient was taken to the Harbor UCLA Psychiatric Emergency Room (ER) and placed on a 51/50 hold. A review of the psychiatrist’s progress note, dated August 22, 2025, revealed that on August 19, 2025, the Psychiatric ER contacted the Gardena Retirement Center and spoke with Administrator A1 regarding the patient's return to the facility. A1 informed them that the facility did not want the residents to return. On August 25, 2025, the LPA interviewed A1, who reiterated that the facility did not wish to accept the resident back.

During a file review for R1 conducted by LPA Richard, it was noted that R1 was admitted to Gardena Retirement on June 25, 2015. A review of the admission agreement for Gardena Retirement Center revealed that the facility is required to provide residents with 30 days' written notice before any changes (or 3 days if approved by the Department of Social Services). However, there is no record of the facility providing 30 days' notice to either the residents or their responsible party.

Based on interviews and record reviews, the preponderance of evidence has been met; therefore, the allegation is Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099D.

Deficiencies were issued.

An exit interview was conducted, and plans for correction were developed. A copy of this report and appeals rights was reviewed and left with the facility Staff Christina Novoa

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250820134633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GARDENA RETIREMENT CENTER
FACILITY NUMBER: 197607366
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2025
Section Cited
CCR
87468.1(a)(2)
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(a) Residents in all residential care facilities for the elderly shall have all the following personal rights: (2) to be accorded safe, heathful and comfortable accommodations...

This requirement was not met as evidence
By:
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The Administrator will make arrangements to bring the resident back to the facility. And also the Administrator will review title 22 eviction regulations and submit a statement of acknowleding the review and understanding of title 22. POC 09/03/2025 via email to LPA Antonine.Richard@dss.ca.gov
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Based on record review and interviews, the Licensee did not permit R1 to return back to the facility which posed a potential personal rights risk to the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3