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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 11/06/2023
Date Signed: 11/06/2023 12:21:02 PM

Unsubstantiated


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
11/01/2023 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231101121819
FACILITY NAME:NORWALK RETIREMENT VILLAFACILITY NUMBER:
198603172
ADMINISTRATOR:CHANEL A. SANCHEZFACILITY TYPE:
740
ADDRESS:11515 FIRESTONE BLVDTELEPHONE:
(562) 379-9200
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:80CENSUS: 70DATE:
11/06/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Elizabeth MartinezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not provide resident with meals.
Staff stole money from a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint visit to investigate the above allegations. LPA met with Elizabeth Martinez (Business Office Manager/Assistant Administrator) and discussed the purpose of today’s visit.

During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Resident #7’s (R-7) file and obtain relevant documentation. LPA also interviewed Staff #1 (S-1) through Staff #5 (S-5) and Resident #1 (R-1) through Resident #7 (R-7).

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
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 28-AS-20231101121819
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: NORWALK RETIREMENT VILLA
FACILITY NUMBER: 198603172
VISIT DATE: 11/06/2023
NARRATIVE
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Allegation: Staff did not provide resident with meals. It has been alleged that when a resident misses a meal, the facility will not feed the resident. Staff interviews revealed that the facility provides (3) meals and (2) snacks per day. Staff interviews revealed that meal times are as follows: breakfast is from 7:45 A.M. to 9:30 A.M.,lunch is from 11:30 A.M. to 1:30 P.M. and dinner is from 4:30 P.M. to 5:45 P.M. Per staff interviews, when a resident shows up after the meal times, staff still provide a meal for them. Interviewed staff indicated they have not received any complaints/concerns in regards to residents not receiving their meals. Interviewed residents indicated meals are available (after the meal times) as well. Interviewed residents indicated they have not heard anyone complaining about staff not providing residents with meals. Staff and resident interviews do not corroborate this allegation.

Allegation: Staff stole money from a resident. It has been alleged that a staff member stole money from a resident. Staff interviews revealed that staff do not steal money from residents. Interviewed staff indicated they have not received any complaints/concerns in regards to this matter. Interviewed staff indicated they are trained in resident rights and mandated reporting. Interviewed residents indicated staff do not steal their money. Interviewed residents indicated they have not heard other residents complaining about staff stealing their money. Interviewed residents indicated they do not any concerns in regards to this matter. Staff and resident interviews do not corroborate this allegation.



Based on record review and interviews conducted the findings indicate, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Elizabeth Martinez.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2