197607966-5-19-2020-11-AS-MVAO-BR4PEH-20200701111510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 05/15/2020
Date Signed: 05/19/2020 03:57:59 PM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2019 and conducted by Evaluator Erik Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20190703101907

FACILITY NAME:	VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES		FACILITY NUMBER:	197607966
ADMINISTRATOR:	JULIAN MANALO		FACILITY TYPE:	740
ADDRESS:	11500 NIMITZ AVENUE		TELEPHONE:	(424) 832-8200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90049
CAPACITY:	84	CENSUS: 73	DATE:	05/15/2020
		UNANNOUNCED	TIME BEGAN:	02:43 PM
MET WITH:	Denise Davenport, Chief of Domiciliary Services		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility denied resident food
Resident denied medical attention
Staff yells at residents
Staff threatens residents
Staff harasses residents
Residents not awarded privacy

INVESTIGATION FINDINGS:

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

On this date, Licensing Program Analyst (LPA) Erik Brown conducted a complaint tele-visit to deliver findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Denise Davenport, Chief of Domiciliary Services.

During the initial visit on 7/9/2019, LPA discussed the allegation with Administrator Julian Manalo. LPA toured the inside of the facility, toured the outside grounds and facility parking lot, interviewed residents #1-2 (R1-R2), staff #1-4 (S1-S4), took pictures and collected pertinent documents related to the investigation.

During the visit on 7/16/2019, LPA interviewed residents #3-6 (R3-R6), staff #5-8 (S5-S8) and collected further documentation related to the investigation.

(Report continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020

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 3

Control Number 11-AS-20190703101907

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES	FACILITY NUMBER: 197607966
	VISIT DATE: 05/15/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During the visit on 7/25/2019, LPA toured the facility, interviewed residents #1-2 (R1-2), staff #5-6 (S5-S6), Staff #9-10 (S9-S10), and collected further documentation related to the investigation.

During the visit on 8/26/2019, LPA interviewed staff #11-12, contacted Veterans Home of California Barstow, and collected further documentation related to the investigation.

During the visit on 10/4/2019, LPA discussed the allegation with Denise Davenport. LPA toured the facility, interviewed residents #7-12, and collected further documentation related to the investigation.

The investigation revealed the following for allegations:

Based on interviews, facility Staff generally stated that they have never witnessed a resident being denied food, medical attention or privileges during their time at the facility. Staff also generally stated that they have never witnessed other staff yelling at, threatening, or harassing a resident. S2 stated that she has never witnessed a resident be denied food during her tenure at the facility. S2 stated that there are special requests that the kitchen honors and that the servers and cooks take special requests for vegetarians. S2 stated that residents can have “more than the usual servings sizes” if requested, however, for health and safety precautions, the servers must notify the Admin to get the OK from them. S4 stated that residents can always request to have more food. S4 stated that she knew who the complaint was about and said the issue with R1 and R2 is that they always want to take the food to go. S4 stated that there is a safety concern because the kitchen staff don’t want the food to go bad and make the residents sick. S4 stated that if the residents eat the food in the dining room then there would be no issue. S9 stated that vegetarian options on the “always available” menu are available during any meal period. S9 stated that items such as tofu, falafel, and mixed vegetables are available, along with veggie burgers and vegetarian bacon. S9 stated that R2 has a pattern of refusing her vitals and getting weighed.

Based on interviews with Residents#3-12 (R3-R12), residents generally stated that they haven’t been denied food or medical attention. Residents also generally stated that staff does not yell, threaten or harass them, and that they are awarded their privacy at the facility.

(Report continued on LIC9099-C)

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20190703101907

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES	FACILITY NUMBER: 197607966
	VISIT DATE: 05/15/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

To address the allegations of privacy invasion inside the resident bedrooms, LPA tested intercom system in room E214 with the assistance of staff#10 who is a Certified Nurse Assistant. The intercom system in the residents’ room comes with a hand-held device that has a big red button which can be pushed by residents if they need assistance. Once the button is pushed, the system sends an alert to the nurse’s station. The nurses then can see the alert and pick up the phone to be able to speak with residents. Once the phone is picked up at the nurse’s station, it opens the line of communication from the nurse’s station to the resident’s room and works the same as a telephone connection. The red button does not need to be pressed again if the phone is picked up at the nurse’s station. If the call is hung up at the nurse’s station, the communication is stopped, and the resident must press the big red button again to be able to speak with someone at the station. Staff #10 stated that residents must initiate the calls, and that calls cannot be placed to residents’ rooms from the nurse’s stations.

Based on LPA Brown’s observations, the records that were reviewed (physician’s reports, physician’s orders, code of conduct, monthly newsletter, admissions agreements, food menus), and the interviews that were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

A telephonic exit interview was conducted with Denise Davenport, Chief of Domiciliary Services, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3