197607966-9-19-2023-11-AS-JHAD-CY7W3C-20231204155542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 05/25/2023
Date Signed: 09/19/2023 12:48:42 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
11/01/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221101132438

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: 57	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Teresa Starks		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility staff are not providing a safe environment for residents in care.
Facility staff are insufficient to meet the needs of the residents.
Facility staff are not communicating properly with residents.
Facility staff are not properly trained to assist residents.

INVESTIGATION FINDINGS:

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On 05/25/23 Licensing Program Analyst (LPA) Perry Scott conducted a continuation complaint investigation for the allegations listed above, that was initially conducted on 11/01/2022 by LPA Troy Agard. LPA met with Teresa Starks, Deputy Administrator, and explained the purpose of this visit is to deliver findings.

The investigation consisted of the following:

On 11/01/2022 LPA Agard toured the facility grounds for the main building of the Residential Care Facility for the Elderly (RCFE). The RCFE facility consists of 2 floors, including 34 double rooms and 16 single rooms, a total of 50 bathrooms, a bathing room, barbershop, activity room, dining room, 4 dens and a kitchen. LPA interviewed staff, residents, a witness, and reviewed records. LPA Agard requested documents, which were received at the time of visit.

The investigation revealed the following: Regarding allegation #1: Facility staff are not providing a safe environment for residents in care.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 5

Control Number 11-AS-20221101132438

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: 05/25/2023

NARRATIVE

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On 11/01/22, LPA Agard interviewed S1-S3, and W1. S1-S3 and W1 denied the allegation that Facility staff are not providing a safe environment for residents in care. S1-S3 and W1 stated that none of the residents has ever come to them stating they did not feel safe in the facility. LPA interviewed R1-R8 about the allegation and 5 of 8 denied the allegation.

Based on interviews there is insufficient evidence to support the allegation: Facility staff are not providing a safe environment for residents in care. 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.

Allegation # 2: Facility staff are insufficient to meet the needs of the residents.

On 11/01/22, LPA Agard interviewed S1-S3, and W1. S1-S3 and W1 denied the allegation that Facility staff are insufficient to meet the needs of the residents. S1-S3 and W1 all report that there are sufficient staff to meet the needs of the facility. LPA Agard interviewed R1-R8 about the allegation and 5 of 8 denied the allegation. Most of the residents don’t see a problem with staffing.

Based on interviews there is insufficient evidence to support the allegation: that Facility staff are insufficient to meet the needs of the residents. 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 allegations are Unsubstantiated.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20221101132438

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: 05/25/2023

NARRATIVE

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Allegation #3: Facility staff are not communicating properly with residents.

On 11/01/22, LPA Agard interviewed S1-S3, and W1. S1-S3 and W1 denied the allegation that Facility staff are not communicating properly with residents. Staff state that they have an open-door policy where residents can come to the door and express any issues they may have. In addition, they can file a grievance with the social worker, who then logs in the grievance, and tracks the outcome. W1, also states that there is an open-door policy for the residents as well as the grievance process. LPA interviewed R1-R8 about the allegation and 5 of 8 denied the allegation. Most of the residents don’t have an issue with the staff and communication.

Based on interviews there is insufficient evidence to support the allegation: that Facility staff are not communicating properly with residents. 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 allegations are Unsubstantiated.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20221101132438

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: 05/25/2023

NARRATIVE

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Allegation # 4: Facility staff are not properly trained to assist residents.

On 11/01/22, LPA Agard interviewed S1-S3, and W1. S1-S3 and W1 denied the allegation that Facility staff are not properly trained to assist residents. S1-S3 and W1 state that they receive ongoing in-service training monthly as well as training through Relias.

During a record review, LPA reviewed the staff scheduled for October and November of 2022. LPA did not identify any patterns of the facility having insufficient staffing. LPA did not identify any safety concerns, lack of communication with residents or staff not being properly trained based on residents’ interviews.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20221101132438

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: 05/25/2023

NARRATIVE

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Based on interviews there is insufficient evidence to support the allegation: that Facility staff are not properly trained to assist residents. 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 allegations are Unsubstantiated.

No deficiencies were cited during this visit.

An exit interview was conducted with Teresa Starks, Deputy Administrator, and a copy of the
complaint report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5