197607966-2-4-2025-11-AS-JHAD-DF4VSN-20250325164150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:30:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Deborah Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250131114522

FACILITY NAME:	VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES		FACILITY NUMBER:	197607966
ADMINISTRATOR:	DEVON YOUNG		FACILITY TYPE:	740
ADDRESS:	11500 NIMITZ AVENUE		TELEPHONE:	(424) 832-8200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90049
CAPACITY:	84	CENSUS: 64	DATE:	02/04/2025
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Aithi Hong		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not follow sanitary practices for food storage units.

INVESTIGATION FINDINGS:

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On February 4, 2025, Community Care Licensing Department staff Deborah Lee conducted an unannounced complaint visit to the address the allegation listed above. The department staff was greeted by the Standars and Compliance Manager Aithi Hong, who granted access to the facility and the purpose of the visit was discussed.

This complaint alleges that Resident 1(R1) passed away on 1/23/25 at 9:30am and his body was placed in trailer generally used to store food in case of an emergency. R1’s body was allegedly picked up approximately 8:00pm from the loading dock where the trailers are located.

The investigation consisted of the following: The department staff conducted a tour of facility both inside and out, made observation of food service and storage areas including the loading dock, reviewed resident rosters (dated 1/23/25 and 2/4/25), and interviews conducted with 3 staff (S1- S3) and the Standard and Compliance mnager (A1).
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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 11-AS-20250131114522

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES	FACILITY NUMBER: 197607966
	VISIT DATE: 02/04/2025

NARRATIVE

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Allegation: Staff did not follow sanitary practices for food storage units

The department staff conducted interviews with the Standards and Compliance Manager (A1) and Staff 1-Staff 3 (S1-S3). A1 reported that there has been no residents death in the month of January 2025. She also reported that when a resident passes away, the body is not moved until a mortuary or coroner arrives to remove the body and it is typically taken through the front door. A1 stated that "our policy is they come through the front door and they exit through the front door." Lastly, A1 stated that it is not possible for a body to be picked up from the loading dock or any place else. Of the 3 staff interviewed, 3 out of 3 staff state that when a person passes away the body is not moved and the process is as follows: the mortuary or corner is called, a family member is call, there is a small flag ceremony, the body is picked up and taken through the front doors. Lastly, 3 out of 3 staff and A1 stated that any resident who passed away has never been placed in an area where food is stored.

The department staff observed food service and storage areas and found that all safety/infectious disease precautions were used such as wearing hair nets, masks, gloves and washing hands. All storage freezers where observed to be clean and sanitary. All items were appropriately stored.

The department staff obtained and reviewed a copy of Residents' roster (dated 1/23/25 and 2/4/25) and did not observe any resident with initials matching R1's as indicated on the complaint.

Based on the information provided, documentation reviewed, and interviews conducted, the department found no evidence to support the allegation mentioned above.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited for the above allegations. Exit interview was conducted. A copy of this report was provided to Aithi Hong, Standards and Compliance Manager.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC9099 (FAS) - (06/04)

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