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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197605591
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:10:37 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
05/02/2022 and conducted by Evaluator Christina Hadley
COMPLAINT CONTROL NUMBER: 28-AS-20220502074202
FACILITY NAME:WESTMINSTER GARDENSFACILITY NUMBER:
197605591
ADMINISTRATOR:ANDREW M SMITHFACILITY TYPE:
741
ADDRESS:1420 SANTO DOMINGO AVENUETELEPHONE:
(626) 358-2569
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:200CENSUS: DATE:
08/25/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
10:01 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation #5 - Facility did not uphold resident's rights to make choices concerning their dally life in the facility.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
During the course of the investigation into the factors surrounding this allegation, it was determined that the Resident was free to make choices concerning daily life activities. Additionally, the resident's spouse took resident out of community on multiple occasions including choosing to take him to Adult Day Care center to participate in activities with other participants during the day.
It has also been determiend that the Resident's spouce contacted the Wellness Office asking for assistance with care for her husband. The resident was then transferred temporarily to Bridge Care in Assisted Living to ensure that the appropriate level of care was provided.

Allegation Finding: Unsubtantiated.
The Department was unable to obtain evidence to support this allegation. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Allison NakatomiTELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Christina HadleyTELEPHONE: (916) 651-7853
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
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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