197607718-6-3-2022-11-AS-JHAD-CGS2P7-20220728173354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 05/27/2022
Date Signed: 06/03/2022 08:12:42 AM

Substantiated

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
05/26/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220526144438

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:	05/27/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	GWENDOLYN CRAIG		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility door is in disrepair

INVESTIGATION FINDINGS:

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On 5/27/2022, Licensing Pogram Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. Upon arrival, LPA called the facility to conduct a risk-assessment. LPA spoke with Medication Technician (MedTech) Victoria Calderon who confirmed the facility is Covid-19 free. LPA met with MedTechVictoria Calderon and Administrator Gwendolyn Craig joined the visit shortly after. LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA toured the facility with MedTech Calderon, interviewed Administrator Gwendolyn Craig, Medication Technician Victoria Calderon and Receptionist Hailey Garrett. LPA obtaied a copy of the resident roster and staff roster.

Report continued in LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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-20220526144438

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: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 05/27/2022

NARRATIVE

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Investigation Revealed the following:

ALLEGATION: Facility door is in disrepair

It is alleged that the facility door is in disrepair. The Reporting Party (RP) reported that the front main door lock has not been working for a month and a half. RP is concerned about the residents' safety. Based on interviews with Staff (S1-S3), the front main door has been broken and does not lock. S1 revealed the door has been broken since 4/22/2022. LPA observed the front main double glass door on the main entrance does not lock.

Based on LPA’s records review, observation and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation of “Facility door is in disrepair" is found to be Substantiated.

Based on LPA Montoya's records review, the facility was already cited for the same door (broken front double glass door) on 5/17/2022 and the Proof of Correction is due on 6/14/2022. Therefore, no additional citation will be issued during today's visit.

An exit interview was conducted and a copy of the report was provided to Administrator Gwendolyn Craig.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC9099 (FAS) - (06/04)

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