198320076-12-12-2023-11-AS-MVAO-CZLRTT-20240118121845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320076
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:55:33 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
12/11/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20231211141225

FACILITY NAME:	STERLING SENIOR COMMUNITY V		FACILITY NUMBER:	198320076
ADMINISTRATOR:	NAREZ, ALBERTO PIMENTEL		FACILITY TYPE:	740
ADDRESS:	1200 W 226TH		TELEPHONE:	(714) 891-0088
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90502
CAPACITY:	6	CENSUS: 5	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	ARNOLD MENDOZA		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff failed to properly administer resident’s medications.
Facility failed to maintain complete and accurate staff records.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 12/12/2023 at 9:10 AM, Licensing program analyst (LPA) Lourdes Montoya conducted an initial 10-day complaint visit to this facility to investigate the allegations mentioned above. LPA met with House Manager Arnold Mendoza and spoke with Administrator Alberto Pimentel via telephone. LPA explained the purpose of today’s visit. Administrator Alberto arrived at 3:15 PM and joined the visit. LPA observed four residents present during the visit and one resident is in the hospital.

The investigation consisted of the following: LPA Montoya toured the facility with House Manager Arnold Mendoza. LPA obtained copies of the following: Staff roster, resident roster, staff records and five residents’ (R1-R5) service records and other pertinent records. LPA interviewed two staff (S1-S2). LPA attempted to interview all four residents (R1-R4), but they all refused the interview.

Report continued in LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20231211141225

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: STERLING SENIOR COMMUNITY V	FACILITY NUMBER: 198320076
	VISIT DATE: 12/12/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Facility staff failed to properly administer resident’s medications.

On 12/12/2023, LPA Montoya interviewed two staff (S1 and S2). Both staff denied the allegation that staff failed to properly administer residents’ medications. Based on LPA’s review of the medication administration records (MAR), staff did not fail to properly administer resident’s medications.

Allegation: Facility failed to maintain complete and accurate staff records.

On 12/12/2023, LPA interviewed two staff (S1 and S2). Both staff denied the allegation that staff failed to maintain complete and accurate staff records. Based on LPA’s review of staff records, staff did not fail to maintain complete and accurate staff records.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; Therefore, the above allegations, "Facility staff failed to properly administer resident’s medications and Facility failed to maintain complete and accurate staff records” are found to be UNSUBSTANTIATED.

Exit interview conducted and a copy of the report was provided to House Manager Arnold Mendoza.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2