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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607718
Report Date: 06/16/2022
Date Signed: 06/16/2022 03:40:13 PM

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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2022 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220614133156
FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY:96CENSUS: DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not provide a safe environment for residents in care
INVESTIGATION FINDINGS:
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On 6/16/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint visit at this facility. LPA spoke with staff via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms.
LPA arrived at facility and explained the purposed of the visit is to investigate the allegation listed above.

The investigation consisted of the following: On 6/16/2022 LPA conducted a tour of facility grounds and reviewed records for staff and residents. LPA conducted interviews with staff (S1-S5), and residents (R1-R7). LPA Cifuentes requested and received the following documents: Client roster, staff roster and other documents relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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 2
Control Number 11-AS-20220614133156
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: 06/16/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff did not provide a safe environment for residents in care

The complainant alleges that staff are not keeping residents safe as the front doors of the facility are broken and no one is monitoring who is entering and exiting the facility. LPA noted that facility has double doors and that left door was not locked and could be pulled open, while right door could not be opened from the inside or the outside. There were no staff stationed in lobby at the time LPA walked in, but staff appeared within a few minutes. Lobby area has a table and chair where a staff person sits at, also available are sing in longs for visitors and staff as well as a wall thermometer. Per administrator Gwendolyn Craig, front door is broken and has to be completely replaced. A contractor has been called, door has been measures and has been ordered. While they wait for the repair, a staff person has been assigned to sit near the front doors twenty-four hours a day, seven days a week. The staff will leave to sign in and out for lunch and for restroom breaks. LPA Cifuentes interviewed residents (R1-R7) regarding the allegations and of those interviewed, 4 out of 7 stated they feel safe and there is someone stationed in front of the broken door. LPA interviewed staff (S1-S5) regarding the allegation. Of those interviewed 4 out 5 stated there are facility staff stationed by the front doors.

Based on information gathered, the department did not find sufficient evidence to support allegations " Staff did not provide a safe environment for residents in care.” 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 was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Medtech Victoria Calderon.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2