197607430-4-14-2023-11-AS-MVAO-CR2SEP-20230419134905

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607430
Report Date: 04/13/2023
Date Signed: 04/14/2023 06:47:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
03/16/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230316084904

FACILITY NAME:	COMFORT HOME FOR ELDERLY		FACILITY NUMBER:	197607430
ADMINISTRATOR:	SOCORRO TRINIDAD		FACILITY TYPE:	740
ADDRESS:	2729 WESTWOOD BLVD.		TELEPHONE:	(310) 470-7302
CITY:	WESTWOOD	STATE: CA	ZIP CODE:	90064
CAPACITY:	6	CENSUS: 5	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Socorro "Cory" Trinidad		TIME COMPLETED:	11:59 AM

ALLEGATION(S):

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Resident sustained injuries due to staff neglect..
Staff handled resident in a rough manner.
Staff are not meeting residents diapering needs.

INVESTIGATION FINDINGS:

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On 03/22/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Upon arrival at the facility, LPA verified the person of COVID-19 activity. Based on the assessment, the facility is cleared of COVID-19 infection. LPA met with Administrator Socorro Trinidad. LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed staff #1-#3 (S1-S3), residents #1-#4 (R1-R4), and witnesses #1-#4 (W1-W4). LPA asked questions relevant to the nature of the complaint. A toured the facility inside to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. Personnel Records for (S1-S5)) were provided and reviewed and other documents associated with this complaint.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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-20230316084904

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COMFORT HOME FOR ELDERLY	FACILITY NUMBER: 197607430
	VISIT DATE: 04/13/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident sustained injuries due to staff neglect.
Staff handled resident in a rough manner.

It is alleged that staff neglected to care for residents at this facility which resulted in injuries. The complainant named a resident at this facility who yelled for staff assistance during a shower and was handled roughly. The resident was handled mishandled and suffered scrapes on the back, hips, and legs. The complainant did not have the name of the staff and the resident that was named for this complaint did not exists. Currently, there are five elderly residents residing at this facility. Residents #1-#2 (R1-R2) had no issues with the facility regarding their care or supervision. Due to their health condition, (R3-R4) were interviewed, however unable to provide any information on this matter. Interviews conducted with staff #1-#3 (S1-S3) all confirmed that there are no residents with any injuries. (S1-S3) confirmed that all the residents require assistance with daily living activities and that staff are trained professionals to handle each duty. (S1-S3) routine body checks are performed daily with all residents in care. Interviews conducted with family representatives witness #1-#4 (W1-W4) agreed with the care and services provided at this facility and were complimentary. (W2) claimed since (R2) has been a resident at this facility (R2’s) health condition has only improved and not declined.

Allegation: Staff are not meeting residents diapering needs.

The details of the complaint reported resident #3 (R3) is not adequately clean during diaper changes. The complainant did not have further details on this matter. (S1-S3) reported diaper changes are done after each meal or as needed. (S1) claims there are no residents including (R3) with any diaper rash or injuries that would result from residents being neglected in care. Interviews with witnesses #1-#4 (W1-W4) did not have concerns or issues with the resident’s care. (W1-W4) reported an in-person visit conducted weekly have not observed residents neglected with services. (W1-W4) expressed the facility never had a malodor smell that would result from toileting issues. (W3) stated the facility on every visit have observed to be clean and sanitary. Residents #1-#2 (R1-R2) had no concerns with the facility regarding diaper issues. Due to their health condition, (R3-R4) were interviewed, however unable to provide any information on this matter. The Department inspected visits on 03/22/23 and 04/14/23 did not observe signs of residents neglected in care.
Evaluation Report continues on LIC-9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230316084904

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COMFORT HOME FOR ELDERLY	FACILITY NUMBER: 197607430
	VISIT DATE: 04/13/2023

NARRATIVE

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Based on observation, record analysis, and interviews, there is no evidence to support the allegations to support the allegations mentioned above.

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 conducted with Socorro Trinidad and copy of the report provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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