198320498-11-4-2024-11-AS-RORN-DBUQLA-20241211111537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320498
Report Date: 11/04/2024
Date Signed: 11/04/2024 03:01:25 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
10/29/2024 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 11-AS-20241029094715

FACILITY NAME:	GENERATIONS OF LOS ANGELES ASSISTED LVNG. FACILITY		FACILITY NUMBER:	198320498
ADMINISTRATOR:	CAMARIN JOHNSON		FACILITY TYPE:	740
ADDRESS:	3540 MARTIN LUTHER KING, JR.		TELEPHONE:	(310) 638-4113
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	178	CENSUS: 72	DATE:	11/04/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Camarin Johnson		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff do not intervene when residents engage in physical altercations.

INVESTIGATION FINDINGS:

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

On 11/04/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to the facility listed above to investigate the allegation listed above. LPA was met by Administrator Camarin Johnson, and the purpose of today’s visit was explained.

Investigation consisted of the following: LPA Gonzalez interviewed Administrator (A1) and staff #1-#4 (S1-S4) and residents #1-#6 (R1-R6). Reviewed records and obtained the following documents: resident and staff rosters, Physician’s Report, Appraisal & Needs and Services Plan, Identification and Emergency Information, Preplacement Appraisal Information, discharge paperwork from Norwalk Community Hospital and an incident report dated 10/26/24, and photographs for R1. Additionally, LPA Gonzalez conducted a tour of the facility grounds.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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-20241029094715

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: GENERATIONS OF LOS ANGELES ASSISTED LVNG. FACILITY	FACILITY NUMBER: 198320498
	VISIT DATE: 11/04/2024

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

The investigation revealed the following:

Allegation: Facility staff do not intervene when residents engage in physical altercations. It is alleged that a resident was hit in the face by another resident. A review of records revealed that a photograph was taken on 10/24/24 of R1 because they were observed with swelling under their left eye. An Unusual Incident Report (dated: 10/26/24) was submitted to the department reporting that on 10/25/24 R1 was taken to the hospital due to watered filled pockets that developed around R1 left eye. According to records from Norwalk Community Hospital, R1 was discharged on 10/30/24 with discharge information listing facial trauma, fall reported, and failure to thrive (FTT). Additionally, a follow up photograph was taken on 10/30/24 of R1’s eye when they returned from the hospital.

An interview conducted with the Administrator Camarin Johnson (A1) revealed that a physical altercation between R1 and R2 was never reported, not by the residents or staff. Johnson denies the above allegation ever happened. She stated that R1 has never had any issues with their roommate. Johnson stated that staff observed R1 with swelling, and fluid filled pockets under their eye on 10/24/24. She stated that they were advised by R1’s doctor to monitor and apply warm compress on the affected area, but after they noticed that wasn’t working, they decided to take R1 to the hospital for further evaluation.

LPA conducted interviews with S1-S4, and 4 out of 4 staff interviewed denied the above allegation ever happened. 4 out of 4 staff interviewed stated that R1 was taken to the hospital because swelling was observed on R1’s under eye.

LPA conducted interviews with R1-R6, and 5 out of 6 residents interviewed stated that they are not aware of R1 being hit in the face. 5 out of 6 residents interviewed stated that they are satisfied with the services being provided, and that they love it here at this facility.

Based on interviews, and records reviewed, LPA did not find sufficient evidence to support the allegation, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted with Administrator Camarin Johnson, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2