198320348-10-25-2024-11-AS-JHAD-DAJRAA-20241030125050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320348
Report Date: 10/25/2024
Date Signed: 10/25/2024 10:00:30 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
12/19/2023 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20231219140341

FACILITY NAME:	VILLA DEL SOL		FACILITY NUMBER:	198320348
ADMINISTRATOR:	COELLO, BESSIE L.		FACILITY TYPE:	740
ADDRESS:	4834 NARROT ST.		TELEPHONE:	(310) 292-8425
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 5	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Licensee Bessie Coello		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting resident(s) to fall.
Staff did not allow hospice care to enter facility to provide care to resident(s).
Staff refused to provide authorized presentative residents plan of care.

INVESTIGATION FINDINGS:

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

On 10/25/24 at 9:00 am, Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit to deliver findings. LPA met with Licensee Bessie Coello as the purpose of today’s visit was explained.

The investigation consisted of the following: On 12/28/23 LPA Gibbs conducted initial visit, LPA Gibbs toured the facility, interviewed Staff 1-2 (S1-S2), and reviewed and received documents pertinent to the investigation. On 08/29/24 LPA Villegas conducted interviews between 11am-11:45am with staff 1-2 (S1-S2), and obtained copies of the staff and resident rosters, copies of the communication logs dated August 2023- November 2023, copies of communication between S1 and R1's POA and copies on sign in sheets with temperatures taken upon entry of the facility. On 08/29/24 LPA obtained copies of documents pertinent to the investigation for resident #2 (R2). On 10/10/24 between 9am-12:00 pm LPA Villegas conducted interviews with residents R2-R5 (R2-R5), LPA Villegas was unable to interview R6-R7 due to communication barriers.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

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 3

Control Number 11-AS-20231219140341

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: VILLA DEL SOL	FACILITY NUMBER: 198320348
	VISIT DATE: 10/25/2024

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

Allegation: Lack of supervision resulting resident(s) to fall.
It is being alleged that there is a lack of supervision resulting resident(s) to fall. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S1 regarding the allegation above, S1 denied the allegation above and reported there has never been neglect as all staff are trained in resident transfers. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S2 regarding the allegation above, S2 denied the allegation above. On 10/10/24 between 9am-12pm LPA Villegas conducted interviews with residents 2-5 (R2-R5) regarding the allegation above, 4 of 4 residents interviewed denied the allegation above and reported feeling safe at the facility. R2 has no recollection of falling while receiving care at the facility. On 10/10/24 LPA Villegas was unable to interview R6-R7 due to communication barriers. On 10/10/24 LPA reviewed file for R1, there was no documentation indicating that R1 was a risk fall. On 10/10/24 LPA reviewed file for R2, there was no documentation indicating that R2 was a risk fall. On 07/20/23 CCLD received report regarding a fall R2 had while in dining room chair. Per report R2 lost control of body weight and on right side landing on floor, no pain reported, 911 was called, Administrator and son informed.

Allegation: Staff did not allow hospice care to enter facility to provide care to resident(s).
It is being alleged that Hospice staff arrived at the facility to provide care and licensee turned hospice staff away. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S1 regarding the allegation above, S1 denied the allegation above and reported that during covid the facility would schedule times for the hospice agencies to visit the facility to ensure a bathroom was available and to have support from staff. S1 continued to report that the facility was monitoring the amount of people allowed all at once. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S2 regarding the allegation above, S2 denied the allegation above. On 10/10/24 between 9am-12pm LPA Villegas conducted interviews with residents 2-5 (R2-R5) regarding the allegation above, 4 of 4 residents interviewed denied the allegation above and reporting their visitors have not been denied entry. On 10/10/24 LPA Villegas was unable to interview R6-R7 due to communication barriers. 10/10/24 LPA reviewed sign in sheet for the facility and observed hospice agencies visit dates to be documented. LPA Villegas attempted to contact hospice agency on 08/30/24 and 10/10/24 but was unsuccessful.

Allegation: Staff refused to provide authorized representative residents plan of care.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20231219140341

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: VILLA DEL SOL	FACILITY NUMBER: 198320348
	VISIT DATE: 10/25/2024

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

Allegation: Staff refused to provide authorized representative residents plan of care.

It is being alleged that licensee refused to provide plan of care for R1 when requested. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S1 regarding the allegation above, S1 denied the allegation above and reported that the facility has never refused to provide care plans when requested. On 08/29/24 between 11am-11:45am LPA Villegas conducted interview with S2 regarding the allegation above, S2 denied the allegation above and reported that if requested, document copies are provided. On 10/10/24 between 9am-12pm LPA Villegas conducted interviews with residents 2-5 (R2-R5) regarding the allegation above, 4 of 4 residents interviewed denied the allegation above. On 10/10/24 LPA reviewed copies of email communication between R1's POA, licensee and hospice agencies, LPA observed that care plan was sent via email on 10/23/23, 11/10/23, and 11/12/23.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Licensee Bessie Coello, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3