198603172-1-16-2024-28-AS-LHIS-CZRPWX-20240123104127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603172
Report Date: 12/07/2023
Date Signed: 01/16/2024 10:59:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/09/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231109161630

FACILITY NAME:	NORWALK RETIREMENT VILLA		FACILITY NUMBER:	198603172
ADMINISTRATOR:	CHANEL A. SANCHEZ		FACILITY TYPE:	740
ADDRESS:	11515 FIRESTONE BLVD		TELEPHONE:	(562) 379-9200
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	80	CENSUS: 68	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Chanel Sanchez		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff failed to assist resident with diaper change.
Facility did not allow visitors, violating residents personal rights.
Facility failed to keep resident(s) furniture in good repair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Nicol Wesley Licensing Program Analyst (LPA) Nicol Wesley conducted the Subsequent complaint visit to investigate the above allegations. LPA met with Adminstrator Chanel Sanchez to discussed the purpose of today’s visit.

LPA Wesley requested copies of: resident files, staff files, shower log, resident shift report, interviews with residents, interviews with staff, and interviews with resident #1.

Regarding allegation: Staff failed to assist resident with diaper change. LPA interviewed 7 out of 8 residents who said the facilty staff assists them with diaper changes and facility showers on time. LPA interviewed 4 staff members who said they provide the residents baths and showers in a timely manner. LPA interviewed all 4 staff who indicated that resident #1 never wants to get changed when the staff is available to change them, and he doesnt' want to be bothered when he's sleeping, or is going outside to smoke. Staff said
Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231109161630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NORWALK RETIREMENT VILLA	FACILITY NUMBER: 198603172
	VISIT DATE: 12/07/2023

NARRATIVE

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they try to work with the resident, but he yells at them and starts cursing them out. LPA interviewed resident #1 but was not successful because resident #1 was using foul language.

Regarding allegation: Facility did not allow visitors, violating residents personal rights. LPA interviewed 7 out of 8 residents who said the facility have not denied any visitors from coming to the facility last month in November 2023 due to covid or any other reason. The 7 residents said when the pandemic first hit in 2020 they denied visitation because everyone in the facility had COVID and the hospitals were full and they could take the clients who were effective, so to stop the spread they denied visitor. This was supported by the CDPH and CCLD. LPA interviewed 8 staff who said they haven't denied any visitation last month November 2023, but when the COVID outbreak was high, they weren't allowing any visitation in the beginning.

Regarding allegation: Facility failed to keep resident(s) furniture in good repair. LPA interviewed 7 out of 8 residents and they indicated that if anything breaks in their room, the facility is good about repairing or replacing it. LPA interviewed 4 staff who indicated that resident #1's bed is not broken, you need 2 people to assist with putting it up or down. LPA interviewed resident #1 but was not successful because resident #1 was using foul language.

Based on the interviews conducted with staff, clients, review of client files and facility records, there was not enough supportive evidence to concur with the reported allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

A copy of this report was given to Chanel Sanchez, during the exit interview.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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