197607966-9-27-2022-11-AS-UCOL-CL8UYY-20221116150040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 09/27/2022
Date Signed: 09/27/2022 02:50:29 PM

Unsubstantiated

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
09/19/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220919160220

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: 56	DATE:	09/27/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Chief, Domiciliary Services, Denise Davenport		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Failure to provide timely medical attention .

INVESTIGATION FINDINGS:

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On 09/27/2022 Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation for the allegation listed above. LPA met with Denise Davenport, Chief, Domiciliary Services, and explained the purpose of this visit is to gather information regarding the complaint allegation.

On 09/27/2022 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, meditation room, dining room, 4 dens and a kitchen. LPA interviewed staff, residents, and reviewed records. LPA Agard requested the following documents, which were received at the time of visit: 1) a copy of the resident roster, 2) copy of the staff roster, and 3) R1’s physician report.

On 09/27/2022, LPA delivered findings.
Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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-20220919160220

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: 09/27/2022

NARRATIVE

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The investigation revealed the following…Regarding the allegation: Failure to provide timely medical attention. It’s being alleged that a resident was refused timely medical attention when they asked a staff to call for emergency services. LPA interviewed 5 out of 56 residents in total. 3 out of 5 denied the allegation to be true. R3 states, “without a question they would get me medical attention if I needed. I’ve seen it happened. My roommate has significant things going on and they are always getting them medical attention quickly.” R4 states, “I have my own car so I can go and drive right over to building 500. If I tell the nurse, I have to wait for the ambulance, they have to take your vitals and then they take you to the hospital.” R5 states, “it happened twice, and they were prompt.” R1 states, “S3 refused to call 911 after I told them I had a medical emergency.” R2 states, “sometimes I can’t get medical assistance right away because they are so busy.”

During interviews with staff, LPA Agard interviewed 2 out of 22 and attempted 1 additional interview: 2 out of 3 staff interviewed denied the allegation to be true. S1 states, “S3 followed the proper protocol, they called someone to assess the resident, the night supervisor, and notified the doctor. The supervisor came in with the nurse, but the resident was already upset and mad.” S2 states, “R1 has a history of being impatient. We were just trying to go to the proper channels. We didn’t refuse them medical treatment. We were just doing things that we were trained to do.” S3 was unavailable for an interview. During an interview with a witness they state, “R1 basically needs to go to the emergency room when that event happens. I think the missing part is the first part of our conversation that they might have missed. They need to be evaluated first. We need to evaluate the urgency and the emergency of the situation.”

LPA Agard reviewed the following records: a staff roster which was not dated. The staff interviewed matches with the roster. A resident roster dated September 2022. All residents match with the roster. R1 refused to provide facility or LPA with discharge paperwork.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. 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.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC9099 (FAS) - (06/04)

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