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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320013
Report Date: 05/07/2025
Date Signed: 05/07/2025 01:57:26 PM

Unsubstantiated


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
04/29/2025 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250429144945
FACILITY NAME:SENIOR MANOR CARE IIIFACILITY NUMBER:
198320013
ADMINISTRATOR:STEPHEN GRADNEYFACILITY TYPE:
740
ADDRESS:2423 SANTA FE AVETELEPHONE:
(310) 212-0883
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 5DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Rodolfo LozadoTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not respond to resident's call bell in a timely manner.
INVESTIGATION FINDINGS:
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On 5/7/25, at 9:40am, the department conducted a complaint visit to the facility and was greeted by Rodolfo Lozado, Administrator Assistant. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4) and resident (R1) from 10:00am-2:00pm. The department received the following: Resident Roster (Dated: 04/29/2025), Staff Roster (Dated: 4/21/2025), Pre-Placement Appraisals (Dated: 1/31/25, 3/1/25), ID/Emergency Information (Dated: 1/31/25, 5/8/24, 3/20/25), Resident Appraisal (Dated: 03/01/25), Admission Record (Dated: 7/2/24), Functional Capability Assessment (Dated: 3/1/25), Admission Agreement (Dated: 3/20/25), Incident Report (Dated: 4/20/25) and Physicians Reports (Dated: 01/31/25, 3/17/25), were obtained from the facility.

Report Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 2
Control Number 11-AS-20250429144945
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: SENIOR MANOR CARE III
FACILITY NUMBER: 198320013
VISIT DATE: 05/07/2025
NARRATIVE
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Allegation- Staff did not respond to resident’s call bell in a timely manner.

It is alleged that staff allowed a resident who had fallen, to lay on the floor without giving the resident any assistance until 7:00am the following morning. It was reported that the resident called for assistance by pushing their call button at their bedside, but no one answered their call for assistance. On 05/7/25 from 10:00am-2:00pm the department interviewed staff (S1-S4) and resident (R1) about the allegation. 4 of 4 staff denied the allegation that the Staff did not respond to resident’s call bell in a timely manner. Staff stated that the resident did not have a fall, the resident slipped off the bed and needed assistance getting up. Staff stated that the resident rang the call bell, and they responded right away to the call. They stated that the resident pushed the bell around 6:30am, they went in to help and used a Hoyer Lift to get the resident on their feet and back in bed. They further state that the resident had no injuries, did not need first aid or medical treatment, and the facility submitted an incident report.

The department interviewed resident (R1) about the allegation and 1 of 1 resident denied the allegation that Staff did not respond to resident’s call bell in a timely manner. Resident stated that the staff does respond to their call button and when they need assistance the staff does not take any more than five minutes to respond to their request. The resident further stated that they are satisfied with the care and supervision they are getting from the staff.

The department reviewed the Incident Report (Dated: 4/20/25) and observed that the report was submitted, and the resident did not have or reported having any injuries or need for medical treatment.



Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff did not respond to resident’s call bell in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No citations were issued.

An exit interview was conducted with Rodolfo Lozado, Administrator Assistant, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
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