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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320262
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:26:15 AM

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
02/14/2025 and conducted by Evaluator Deborah Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250214160338
FACILITY NAME:FLORESMA GUEST HOMEFACILITY NUMBER:
198320262
ADMINISTRATOR:SERRANO, CARLFACILITY TYPE:
740
ADDRESS:1812 E. HARDWICK AVETELEPHONE:
(562) 895-2418
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:6CENSUS: 5DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Myrna MaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not provide adequate food service for a resident
Staff do not meet a resident's hygiene needs
Residents needs are not being met due to lack staff
INVESTIGATION FINDINGS:
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On March 13, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted a subsequent complaint visit to gather information regarding the above allegation(s) and to deliver findings. LPA Lee met with Myrna Ma, Licensee and explained the reason for the visit.

The investigation consisted of the following:
On February 19, 2025 (the initial 10-day), LPA Lee and Myrna Ma toured the facility inside and out. LPA reviewed and requested, the following: staff roster (dated 4/26/24 ), resident's roster (dated 2/19/25 ), Physician's Report for Residential Care for the Elderly (RCFE) for R1 dated (5/29/24) and facility menu. LPA reviewed Admission Agreement for R1(date signed 5/27/24 ), reviewed resident files ( R1-R5). LPA Lee inspected facility's food supply, interviewed (3) residents (R1,R3,R4), and Licensee (A1). On March 13 2025 (subsequent visit), LPA interviewed (2) staff (S1-S2) and 1 Resident (R2). LPA was unable to interview R5 due to R5’s non-verbal status.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 3
Control Number 11-AS-20250214160338
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: FLORESMA GUEST HOME
FACILITY NUMBER: 198320262
VISIT DATE: 03/13/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Staff do not provide adequate food service for a resident.

The detail of the complaint alleges that the food served is not of good quality; it was reported that a dinner meal consisted of ramen noodles with sliced hot dogs inside. LPA interviewed facility Administrator (A1) who denied allegation and stated that nutritious food is always served to the residents and there was never a time when ramen noodles with sliced hot dogs served. On 2/19/24, LPA interviewed residents and of the residents interviewed, (3) out of (4) stated that they are served nutritious food (2) out of (4) stated that they were never served ramen noodles with hot dogs slices inside; (1) out of (4) stated that she has been served ramen noodles before and hot dogs before, but never the combination of ramen with hot dogs slices inside. On 3/13/25, LPA interviewed 2 staff and of those interviewed (2) out of (2) denied allegation and stated that food served is of good quality. (2) out of (2) stated that they have never served a resident ramen noodle with hot dog slices inside. On 2/19/25, LPA observed the facility’s food supply and found that there was a 2-day supply of perishable food and 7-day supply of non-perishable food in the facility. Additionally, there were a variety of fruit and vegetables on hand. On 2/19/25, LPA obtained/reviewed a copy of facility menu and found that hot dogs and ramen noodles were not listed on the menu.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250214160338
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: FLORESMA GUEST HOME
FACILITY NUMBER: 198320262
VISIT DATE: 03/13/2025
NARRATIVE
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Allegation: Staff do not meet a resident's hygiene needs

The detail of the complaint alleges that grooming and hygiene services (including bathing female residents) are being provided by male staff when there is a preference for a female staff. On 2/19/2025 LPA interviewed A1 who denied allegation. However, she did state that a male staff (S2) provides grooming/hygiene services when needed. A1 further stated that she asks if they are comfortable with a staff of the opposite sex to bath/shower them and if there is an issue with it, then they will accommodate the residents' preference. On 2/19/25, LPA interviewed residents and asked how comfortable are they with a male staff bathing them. Of those interviewed, (2) out of (4) stated that they have no problem with a male staff bathing them because that person is respectful of them. (1) out of (4) stated that she is okay with it, but she would prefer a family member help her in that area. On 3/13/25, LPA interviewed (1) resident and she stated that she is okay with the male staff bathing her. On 3/13/25, LPA interviewed staff and (2) out of (2) stated that there has been no complaints that residents are uncomfortable with a staff of the opposite sex bathing them. Additionally staff added that home health or hospice typically come out to provide shower/bathing service, therefore, they do it on occasion.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Allegation: Residents needs are not being met due to lack staff

On 2/19/25 and 3/13/25, LPA observed that there where enough staff tending to the needs the residents in care (2 staff and Administrator present at time of LPA’s visit). LPA obtained/reviewed staff schedule which shows ample staff available to care for the residents. During interviews with residents (4) out of (4) state that their needs are being met.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegations above 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 are UNSUBSTANTIATED.

No deficiencies were cited for the above allegations. Exit interview was conducted. A copy of this report was provided to Myrna Ma Administrator.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3