197607966-4-24-2023-11-AS-RORN-CRVLPG-20230516085553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 04/24/2023
Date Signed: 04/24/2023 02:45:06 PM

Substantiated

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
04/18/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230418140750

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: 60	DATE:	04/24/2023
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Julian Manalo		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility dining rooms are not thoroughly being cleaned in between services.

INVESTIGATION FINDINGS:

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On 4/24/23 at 9:30 am, Licensing Program Analyst (LPA) Perry Scott conducted a complaint visit to the above facility. LPA was met by Julian Manalo, Administrator, and the purpose of the visit was explained.

The investigation consisted of the following:

On 4/24/23, LPA interviewed the administrator, Julian Manalo, staff 1 (S1) and S2-S4, and residents R1-R5. Additionally, LPA obtained copies of resident/staff rosters.

The investigation revealed the following: Allegation- Facility dining rooms are not thoroughly being cleaned in between services

Report continued on LIC9099-C

Substantiated

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: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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-20230418140750

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: 04/24/2023

NARRATIVE

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There was a complaint filed against the facility that alleged that housekeeping was not doing a good job in keeping the dining area, carpeting, and seating clean in between breakfast, lunch, and dinner. LPA interviewed administrator, S1 about the allegation. S1 stated that he believes the allegation is untrue and that the housekeeping staff is doing a great job at cleaning the dining area and has no issues with their performance. The LPA asked S1 if staffing could be an issue in response to the complaint, S1 denied that staffing was an issue and stated that they are adequately staffed at the facility.

On 04/24/23, LPA interviewed S2-S4 about the allegation that the facility dining rooms are not thoroughly being cleaned in between services and 2 of 3 confirmed that there is a staffing issue. They stated that they are in the process of hiring a new person but maintains that they are doing their best with the staff they currently have. It was acknowledged that housekeeping was available from 6am-2pm. And that the following days crew would be responsible for cleaning the dining area for the dinner service for the previous day.

On 04/24/23, LPA interviewed R1-R5 and 5 out of 5 all corroborated that the facilities dining rooms are not thoroughly being cleaned in between services. They all contend that it has been an ongoing issue for the past few years and that they have just learned to adapt to it not being as clean as it should be.

Based on interviews conducted, the preponderance of evidence standard has been met. The administrator failed to keep the dining area, carpeting, and seating areas clean and sanitary throughout the entire day. Therefore, the above allegation: Facility dining rooms are not thoroughly being cleaned in between services is found to be substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

An exit interview was conducted. Plans of corrections were developed and a copy of this report and appeal rights were given to Teresa Starks, Deputy Administrator.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230418140750

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/02/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	The administrator will ensure that the dining room, carpeting, and seating areas are thoroughly cleaned after each meal period. The Administrator will provide the LPA with documentation by email, that the issue has been discussed with the housekeeping supervisors, and a plan has been put in place to address these issues by the POC due date on 05/02/23.
	8 9 10 11 12 13 14	Based on interviews conducted, the licensee did not comply with the section cited above. The licensee did not ensure that the dining area, carpeting, and seating were cleaned in between services (e.g., breakfast, lunch, & dinner). This violation poses a potential health, safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC9099 (FAS) - (06/04)

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