197605591-8-25-2022-28-AS-SGRE-CYFV7R-20231212151128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605591
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:13:43 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 GARDENS		FACILITY NUMBER:	197605591
ADMINISTRATOR:	ANDREW M SMITH		FACILITY TYPE:	741
ADDRESS:	1420 SANTO DOMINGO AVENUE		TELEPHONE:	(626) 358-2569
CITY:	DUARTE	STATE: CA	ZIP CODE:	91010
CAPACITY:	200	CENSUS:	DATE:	08/25/2022
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:			TIME COMPLETED:	09:53 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Allegation #3 - Facility did not inform resident's representative about ongoing evaluations.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Facility informed resident’s representative about ongoing evaluations and included representative and others as desired by representative. Documents capturing multiple conversations and verification of assessment reviewed. Facility informed resident and resident’s representative about ongoing evaluations and process for determining care transitions in the resident’s residency agreement.

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 Nakatomi	TELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Christina Hadley	TELEPHONE: (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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