197607966-12-1-2023-11-AS-UCOL-D3BU24-20240313151119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:20:32 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
11/14/2023 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231114150236

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: 59	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Teresa Starks, Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility illegally evicted a resident in care.

INVESTIGATION FINDINGS:

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On 12/01/2023 at 08:00 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation follow-up visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 and S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections.

The investigation consisted of the following: On 12/01/2023 at 08:00 am LPA España conducted a tour of facility plant with S#1. LPA reviewed resident records of Seven (7) out of Fifty-Nie (59) residents to ensure it was separate, complete, and current which are maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing. LPA España confirmed there are 59 residents. LPA España confirmed there are 34 staff members.

Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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 3

Control Number 11-AS-20231114150236

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: 12/01/2023

NARRATIVE

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LPA conducted an interviews with Five (5) out of Fifty-Nie (59) residents. LPA conducted an interviews with Five (5) out of Thirty-Four (34) staff. Four (4) out of Thirty-Four (34) residents expressed that they had no knowledge of a notice of eviction. Five (5) out of Thirty-Four (34) staff expressed no knowledge of illegally eviction. Four (4) out of Thirty-Four (34) residents expressed that they heard of one person moving out of the facility for unknown reason and had no knowledge of 30 day of eviction notice being given to said person. LPA conducted an interview with Five (5) out of Thirty-Four (34) staff who expressed that the facility following a code of conduct that all resident in care have signed when admitted to the facility.

Per LPA interviews Five (5) out of Thirty-Four (34) staff expressed that at no time did any staff remove any resident in care. Five (5) out of Thirty-Four (34) staff expressed that at no time did any staff tell or suggest that resident must leave the facility. One (1) out of Thirty-Four (34) staff interviewed stated that there is an “Eviction process” that is specified in Admission Agreement and signed by the resident in Admission process Agreement section #19 Condition for Eviction. One (1) out of Thirty-Four (34) staff interviewed stated that the facility follows policies. One (1) out of Thirty-Four (34) staff interviewed stated there is an interdisciplinary plan of care (IDT) policy which is a SNF policy, not a RCFE policy.

Per LPA record reviewed and interviews S#1 and S#2 the purpose of the Interdisciplinary Team is to develop and maintain an interdisciplinary plan of care that meets the individual of any changing needs of the Resident in the Skilled Nursing Facility. One (1) out of Thirty-Four (34) staff interviewed noted that the IDT (Interdisciplinary Team) meets about the following: A. New Admissions: within 14 days from the date of admission; B. Quarterly: within 90 days from the last assessment per MDS schedule; C. Significant Change: within 14 days from when the change was first identified (Reference: Resident; D. Post Fall: within 7 days from the date of any fall (Reference: Accident Prevention policy); and E. Physical Restraints: prior to utilization unless urgent or emergent situation etc. LPA further confirmed based on records reviewed that the facility follows processes which resident(s) have the right to refuse: to select among treatment options be instituted. Per LPA record reviewed the IDT when encouraged by Residents, ask for surrogates and representatives to participate in care planning, including encouraging them to visit the care planning conferences. Per LPA record reviewed Veteran Homes of California Administration which follow the Level of Care Criteria for Residential Care for the Elderly (RCFE) (i.e., 4639 v.1).

Continued 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20231114150236

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: 12/01/2023

NARRATIVE

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Based on the record review and interviews, the facility followed Title 22, Division 6, Chapter 8, Article 04, Operating Requirements, 87224 Eviction Procedures. Therefore, there has been no violation of California Code of Regulations, Title 22, Division 6, and Chapter 8, and no deficiencies are being cited.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to Teresa Starks, Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

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