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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602898
Report Date: 11/13/2024
Date Signed: 11/13/2024 01:15:28 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
09/23/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240923132701
FACILITY NAME:BELLA MANOR IIFACILITY NUMBER:
198602898
ADMINISTRATOR:ATENCIO, CHRISTINAFACILITY TYPE:
740
ADDRESS:7800 E. TULA STREETTELEPHONE:
(310) 953-5518
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:6CENSUS: 5DATE:
11/13/2024
UNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Christina Atencio, AdministratorTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff is sexually abusing resident in care.
INVESTIGATION FINDINGS:
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On 11/13/2024 The California Department of Social Services (CDSS) conducted a subsequent, unannounced, complaint visit at the above-mentioned facility. Community Care Licensing Division (CCLD) staff was met by Christina Atencio, Administrator (S1), and the purpose of the visit was explained.
The investigation consisted of the following: On 09/24/2024, CCLD staff requested and reviewed the following documents: Resident roster, Personnel roster/Staff schedule. Staff one through staff five (S1-S5) staff records. Resident one through resident three (R1-R3) resident records. S1 and CCLD staff toured the facility. On 09/25/2024 and 10/21/2024, CCLD staff conducted further record reviews that have been provided by S1. CCLD staff conducted a tour of the facility and interviewed four (4) out of five (5) residents (R2-R5), one (1) out of 1 witness (W3) and five (5) staff out of forty-two (42) staff (S1-S3, S5-S6). One resident denied CCLD'S interview.

Report continues, see LIC9099C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
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-20240923132701
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: BELLA MANOR II
FACILITY NUMBER: 198602898
VISIT DATE: 11/13/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation, “Staff is sexually abusing resident in care.”, it has been alleged that residents are being sexually abused by a staff while being bathed. Record reviews have revealed the following: R1’s Preplacement Appraisal, dated 07/02/2024, indicates "Periods of confusion and disorientation. Short Term Memory Problem." and needs “help with bathing, hair care, personal hygiene.”. Admissions Agreement, dated 07/03/2024, indicates that R1 started living at the facility on 07/03/2024. Physician’s report (LIC602A), dated 06/27/2024, indicates that R1 is not “able to bathe self” and is “able to dress/groom self”, with partial supervision and that weekly Registered Nurse (RN) visits are required and have been conducted which began on 04/16/2024 lasting through 09/24/2024 and that Mental Condition: (confused/disoriented) is marked as "NO". LIC602A, dated 09/26/2024: Secondary diagnosis: "Delusional Thought". Weekly RN visits still required. Mild Cognitive Impairment (MCI) or Dementia which is checked off as: DEMENTIA. 14a. Mental Condition: (confused/disoriented) is marked as "YES". R1’s Appraisal /Needs and Services plan (ANS), dated 07/08/2024, indicates that R1: “requires extensive assistance with Activities of Daily Living (ADL's) which includes bathing, transfer, grooming and Personal hygiene. R1 has a history of Depression. Mental (Needs): "With short term memory issues" "With periods of confusion and disorientation.". ANS, dated 09/23/2024 indicates that: "R1 was observed with behavioral issues like paranoia, episodes of refusing care, does not want to be touch(ed), R1 claims will get sexually molested. Thinks staff will poison, drug them and contaminate their food. All behaviors reported to hospice and also observe change in resident cognition.". Eight (8) out of forty-two (42) staff were present during an in-service training, which was conducted on 09/23/2024 at 4:00PM, regarding "Dementia, Behavioral Problems, Sexual Harassment, Abuse reporting." which indicates that staff who were present during the in-service training have been made familiar with dementia care, applied behavioral issues, sexual harassment and abuse reporting. Interviews revealed the following: four (4) out of five (5) residents (R2-R5), one (1) witness (W3) and five (5) out of five (5) staff have denied the allegation has taken place. During today’s visit, LPA observed the following: Five (5) out of five (5) Resident(s) were moved out of their beds to the living room (R3-R5). Two (2) residents were transferred via hoyer-lift (R2 & R6), and were also moved to the living room in comfort, via wheelchair. All five (5) Residents (R2-R6) were provided their lunch and feeding assistance was provided via staff five (S5).
According to CCLD’s staff record reviews, observations, and interviews conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated. An exit interview was held with Christina Atencio (S1) and a copy of this report has been provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
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