198320218-9-19-2022-11-AS-SCIS-CRNQFE-20230509120743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320218
Report Date: 09/19/2022
Date Signed: 09/19/2022 03:44:33 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220912165148

FACILITY NAME:	GRANDVIEW GUEST HOME		FACILITY NUMBER:	198320218
ADMINISTRATOR:	SANTOS, JENNICE-RAE RUTA		FACILITY TYPE:	740
ADDRESS:	2444 235TH ST		TELEPHONE:	(310) 782-5045
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 6	DATE:	09/19/2022
		UNANNOUNCED	TIME BEGAN:	09:49 AM
MET WITH:	COTY CABRAL		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff ignores resident.
Staff are making resident feel uncomfortable.

INVESTIGATION FINDINGS:

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On 9/19/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted a 10-day complaint visit at this facility. LPA Montoya called and conducted a risk assessment with Licensee Coty Cabral but Cabral's voicemail box was full. LPA proceeded to the front of the facility and knocked on the door. Coty Cabral opened the door and LPA conducted a risk assessment prior to entering the facility. Cabral confirmed the facility is free of Covid-19. The purpose of the visit was explained.

The investigation consisted of the following: LPA Lourdes Montoya toured the facility with Licensee Coty Cabral. LPA attempted to interview the alleged victim (R1) but R1 was no longer residing in the facility during the visit. LPA was unsuccessful in her attempts to interview R1 by telephone. LPA observed three (3) staff and six (6) residents during the visit. LPA Montoya interviewed all three (3) staff (S1-S3) and three residents (R2, R6 and R7). LPA was unable to interview two residents (R3 & R5) because of their medical conditions and one resident (R4) was sleeping. LPA requested copies of Resident #1’s service records (Identifcation and

REPORT CONTINUED IN LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

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-20220912165148

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: GRANDVIEW GUEST HOME	FACILITY NUMBER: 198320218
	VISIT DATE: 09/19/2022

NARRATIVE

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Emergency Information, Admission Agreement, Physician’s Report, Appraisal/Needs and Services Plan) and the facility’s dementia plan, dementia staff training, staff roster, resident roster, and other pertinent records.

INVESTIGATIONS REVEALED:

Allegation: Staff ignores resident.

It is alleged that staff ignores resident when resident asks for assistance. Based on LPA’s interview with Staff (S1-S3) and Residents (R2, R6 and R7), they have not heard or observed any staff ignoring any resident asking for assistance. Based on LPA's observations and interviews conducted, there is no sufficient evidence to corroborate the above allegation.

Allegation: Staff are making resident feel uncomfortable.

It is alleged that staff are making resident feel uncomfortable. Based on LPA’s interview with Staff (S1-S3) and Residents (R2, R6 and R7), they have not heard or observed any staff making any resident feel uncomfortable. R2 stated all staff are very good to her. R2, R6 and R7 stated they all like living in this home. Based on LPA's observations and interviews conducted, there is no sufficient evidence to corroborate the above allegation.

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 above allegations are unsubstantiated

An exit interview was conducted with Licensee Coty Cabral, and a hard copy of the report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

LIC9099 (FAS) - (06/04)

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