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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:02:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/15/2023 and conducted by Evaluator David Espana
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230815144902
FACILITY NAME:VETERANS HOME OF CALIFORNIA - WEST LOS ANGELESFACILITY NUMBER:
197607966
ADMINISTRATOR:JULIAN MANALOFACILITY TYPE:
740
ADDRESS:11500 NIMITZ AVENUETELEPHONE:
(424) 832-8200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90049
CAPACITY:84CENSUS: 62DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Teresa Starks, AdministratorTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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“Facility staff are harassing residents in care”
“Facility staff did not have resident fill out a valid admissions agreement”
“Facility staff are verbally abusing residents”
“Facility does not have awake staff on night shift”
“Facility staff are smoking marijuana while caring for residents”
INVESTIGATION FINDINGS:
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On 08/23/2023, at 8:05 AM Licensing Program Analyst (LPA) David España met with Teresa Starks, Administrator and Julius Lozano, Supervising Registered Nurse to conduct a complaint investigation to address the allegations listed above. LPA España met with Teresa Starks, Julius Lozano and explained the purpose of this visit.

The investigation consisted of the following: LPA España reviewed records and documents concerning the needs further investigation. LPA España reviewed the interviews of 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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 4
Control Number 11-AS-20230815144902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
VISIT DATE: 08/23/2023
NARRATIVE
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The investigation revealed the following: Regarding the Allegation: “Facility staff are harassing residents in care.” LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. Staff 1-6 (S1-S-6) have provided statements confirming that the facility staff handled the residents appropriately and did not engage in any inappropriate behavior. LPA and LPM asked questions relevant to the nature of the complaint. LPA and LPM were unable to interview Resident 1 (R1) who was in the community. Resident 1 (R1) was contacted by LPA and LPM by telephone and approached R1’s room for interview two times for interview with no response.

Resident 1-6 (R1-R6) displayed no aggressive conduct and provided interviews and provided answers to specific questions to the allegation above. R1-R6 provided context to claimed harassment, however, did not provide a specific connection to said harassment and associated staff to LPA and LPM. R2 reported that in the dining room there was a staff member (unknown staff) who has exhibited harassing behavior, by rushing out residents from the dining room area. R2 shared that he had a difficult situation at this time, contributing to his emotional state, discussed a specific resident at the facility (R2 did not name another resident, just referenced). However, S1-S6 has stated that staff members have not harassed any resident in care. S1-S6 denied any involvement in such actions, refuting the allegation.

The investigation revealed the following: Regarding the Allegation: “Facility staff did not have resident fill out a valid admissions agreement.” LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. During record review of the timeline of events indicated in R1's 3-day eviction notice, LPA and LPM did not observe reasons indicating that R1 was engaging in a behavior which poses an immediate threat to the physical and mental health of himself or others at the facility. However, LPA and LPM did observe that R1 and R2 did fill out a valid admission agreement. Signed admissions agreement stated and showed signatures on all respected admissions agreement pages. LPA España and LPM Coronel interviewed 6 staff, and 6 out of 61 residents who stated everyone signs and agreed to the admission agreement here at the facility.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230815144902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
VISIT DATE: 08/23/2023
NARRATIVE
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The investigation revealed the following: Regarding the Allegation: “Facility staff are verbally abusing residents.” LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. All staff interviewed denied verbally abusing residents in care. 6 out of 61 residents interviewed revealed that no staff verbally abuse residents. There was no corroborating evidence to demonstrate verbal abuse from facility staff. S1-S6 denied any involvement in such actions, refuting the allegation.

The investigation revealed the following: Regarding the Allegation: “Facility does not have awake staff on night shift.” LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. LPA España and LPM Coronel interviewed S5 and S6 who did not express a concern that staff are asleep on night shift. Per S5 and S6 staff are required to be awake at night per the facility management. S5 and S6 stated that there were two staff at night and per the facility protocol staff and are not a sleep in any shifts. LPA España and LPM Coronel interviewed 6 staff who stated that there are sufficient staff and that the staff schedule is updated weekly. S1-S6 denied any involvement in such actions, refuting the allegation.

The investigation revealed the following: Regarding the Allegation: “Facility staff are smoking marijuana while caring for residents.” LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. LPA España and LPM Coronel interviewed 6 staff and 6 out of 61 residents who stated they have not heard or seen the above allegation happen at the facility. S1-S6 denied any involvement in such actions, refuting the allegation.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230815144902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
VISIT DATE: 08/23/2023
NARRATIVE
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The investigation consisted of the following: LPA España and LPM Coronel interviewed 6 staff, 6 out of 61 residents, and reviewed the following documents: client roster, staff roster, residents R1 and R2's records which included admission agreements and eviction notices. The residents’ records were observed and thoroughly reviewed. During the interviews and records review, S1-S6 and 6 out of 61 residents refuted the allegations. Additionally, the staff has reported all special incident reports to all relevant agencies before the complaint, adhering to proper protocols. S1-S6 stated that the staff is well-trained and competent to provide the necessary services to meet the resident’s needs. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegations 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-C were provided to the facility Administrator, Teresa Starks. There were no deficiencies cited. An exit interview was conducted.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4