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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602557
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:26:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/27/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240927115204
FACILITY NAME:ALONDRA GUEST HOMEFACILITY NUMBER:
198602557
ADMINISTRATOR:VILLAFLORES, LOURDESFACILITY TYPE:
740
ADDRESS:11849 ALONDRA BLVDTELEPHONE:
(562) 863-7630
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 2DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Joy Lourdes Villaflores, Administrator TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff did not seek medical attention for resident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate the above allegation. LPA met with Administrator Joy Lourdes Villaflores and discussed the purpose of the visit.

The investigation consisted of LPA interviewing Administrator S#1, two residents (R#1-R#2) and two (2) witness (W#1-W#2). LPA reviewed staff and resident rosters ,R1 LIC 602 and R1 hospital discharge paper work.
The Investigation revealed that R1 had a fall at around 5:00am on September 24th and hit R1 head. S1 stated S1 asked R1 if R1 wanted to go to hospital and R1 refused. On September 25th, 2024, S1 again asked if R1 wanted to go to hospital and R1 refused and S1 provided R1 with Tylenol. On September 26, 2024, R1 agreed to go to hospital and S1 began to arrange for transportation for R1. At first, the medical transportation company Vital Care agreed to pick R1 up at 2 p.m. on September 26, 2024, then it was pushed back to 4 p.m. and then pushed back one more time to 10 p.m. Finally, the hospital contacted facility and explained that there was no bed and to transport R1 tomorrow September 27, 2024 (continued)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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 28-AS-20240927115204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
VISIT DATE: 10/01/2024
NARRATIVE
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On September 27 2024 Vital Care Transportation arrived at 8:15 a.m. and they asked S1 to call 911 due to R1 blood pressure being out of range. S1 called 911 and R1 was transported to Norwalk Community Hospital where R1 was admitted until R1 was discharged on September 30, 2024.
LPA asked S1 why S1 did not call 911 right away when R1 had fall and S1 stated because R1 refused and R1 condition did not appear too serious. LPA asked S1 if she had medical background to make that determination and S1 said no. LIC602 dated 6/20/2020 indicates that R1 is not able to make decisions or exercise good judgment. R1 was inconsistent in R1 answers. R2 could not corroborate the allegation. W2 who is family member stated that W2 was informed of fall and resident refusal. W2 did not remember that day or time of notification. S1 did not notify department of R1 fall, refusal to get medical attention, and hospitalization for three (3) days. S1 did not call 911 for R1 to get medical attention when R1 fell and hit head until three days later on September 27, 2024 on the request of the Vital Care transportation company.

Based on LPA observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

A copy of report, LIC9099D and appeal rights was provided during the exit interview.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240927115204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2024
Section Cited
CCR
87465(g)
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87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...
This requirement is not met as evidence by:
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Administrator will read section 87465(g) and send letter to LPA by POC date stating she understand section 87465(g) and what Administrator will do to prevent this from happening again. .
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R1 had a fall on the September 24, 2024 and S1 did not call 911 until 3 days later. The resident was not given immediate medical attention for the injuries which poses/posed health and safety hazard to people in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3