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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320308
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:19:20 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
07/19/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240719140342
FACILITY NAME:STERLING SENIOR LIVING 3FACILITY NUMBER:
198320308
ADMINISTRATOR:NAREZ, ALBERTO P.FACILITY TYPE:
740
ADDRESS:23025 NICOLLE AVENUETELEPHONE:
(424) 477-5657
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:6CENSUS: 6DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Arnold MendozaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Resident sustained multiple unexplained injuries while in care.
INVESTIGATION FINDINGS:
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On 07/25/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Arnold Mendoza, Administrator, and Alberto Pimentel Narez, Licensee. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegations mentioned above.

The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4), witness (W1), and residents (R1-R4) R1 could not be interviewed due to R1’s health condition R1 is unable to participate in the interview process. Resident Roster (Dated: 07/10/2024), Staff Roster (Dated: 02/02/2024), Unusual Incident Report (Dated: 07/15/2024) ID/Emergency Information (No Date), Physicians Report (Dated: 03/05/2024), Preplacement Appraisal Information (No Date) Appraisal/Needs and Services Plan (Dated: 04/03/2024) and Healthy Lifestyle Hospice Care Notes (Dated: 02/23/2024, 07/17/2024, 07/18/2024, 07/19/2024, & 07/20/2024) for R1 were obtained from the facility.


Report continued on LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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-20240719140342
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 LIVING 3
FACILITY NUMBER: 198320308
VISIT DATE: 08/07/2024
NARRATIVE
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The investigation revealed the following: Allegation #1- Resident sustained multiple unexplained injuries while in care.

The details of the complaint alleged that the resident was observed with contusions all over the body including private area while at the facility. On 07/25/24, from 9:30am- 1:30pm, LPA reviewed facility files, interviewed staff (S1-S4), witness (W1) and residents (R1-R4) regarding the allegation. 4 of 4 staff denied the allegation that the Resident sustained multiple unexplained injuries while in care. Staff stated that R1 did not have any discoloration on R1’s body the night before (07/14/2024). The staff were alerted on the morning of 07/15/2024 that R1 had bruising on R1’s thigh, buttocks, legs, and pelvic area. S1-S4 stated that they did not know how the bruises were sustained. S2 stated that interviews of the residents and staff were conducted, and no one confirmed that they saw or heard anything out of the ordinary during this period.

LPA reviewed Healthy Lifestyle Hospice Care Notes (Dated: 07/17/2024) that stated that R1 has unexplained scattered ecchymosis (bruising), bluish in color that look a few days old, and extend to R1’s private area. LPA also reviewed Healthy Lifestyle Hospice Care Notes (Dated: 07/20/2024) that stated that R1 had new ecchymosis (bruising) that were not present on last visit. Ecchymosis on vagina, left thigh, and anus were noted. R1 had 5”x 6” bruise which was blueish and purple in color, as described in the hospice notes. LPA reviewed R1’s medication and noted that the resident is taking Keppra (500mg), Atorvastatin (10mg), and Baclofen (20mg) which has side effects that causes itching, rashes, and swelling; according to webmd.com. LPA observed that the facility has cameras but S1 stated that the cameras were not working.

LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that Resident sustained multiple unexplained injuries while in care. Residents that were interviewed stated that they have not experienced any unexplained bruising on their body and have not witnessed abuse or heard of any abuse of another resident while in care.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Resident sustained multiple unexplained injuries while in care. 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 deficiencies were cited.

An exit interview was conducted with Arnold Mendoza, Administrator, and a hard copy of this report was provided.

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

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
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