197608888-11-9-2024-11-AS-UCOL-DAYT8C-20241113133005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 09/04/2024
Date Signed: 11/09/2024 09:21:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2024 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240827084632

FACILITY NAME:	WEST PICO TERRACE ASSISTED LIVING CENTER LP		FACILITY NUMBER:	197608888
ADMINISTRATOR:	CHRISTOPHER,MELISSA		FACILITY TYPE:	740
ADDRESS:	6050 W PICO BLVD		TELEPHONE:	(323) 653-5565
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	136	CENSUS: 78	DATE:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Maria Clarizze Punit, Administrator		TIME COMPLETED:	04:52 PM

ALLEGATION(S):

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Staff does not ensure resident is administered medications.
Staff wrongfully evicted resident in care.

INVESTIGATION FINDINGS:

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This is an amendment of the investigation report delivered on 09/04/24. The purpose of this amendment is to provide additional evidence obtained from record reviews. The findings remain Unsubstantiated.

On 09/04/24 the Department of Social Services, Community Care Licensing Division (CCLD), conducted an initial, unannounced, complaint visit at the above-mentioned facility. CCLD staff was met by Maria Clarizze Punit, Administrator (S1) and the purpose of the visit was explained. S1 and CCLD staff toured the facility. The investigation consisted of the following: On 09/04/24 CCLD staff requested and reviewed facility documents, including resident one's (R1's) Medication Administration Record (MAR), R1's Physician's report (LIC602A) and toured the facility. Between 09:00AM and 3:30PM. CCLD staff interviewed seven (7) out of seventy-eight (78) clients and three (3) out of forty-one (41) staff.

Report continues, see LIC-9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

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-20240827084632

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 09/04/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation, “Staff does not ensure resident is administered medications.”, it has been alleged that night staff do not provide residents’ their pain medication (M1) at night. Interviews revealed that five (5) out of seven (7) residents and two (2) out of four (4) staff have denied the allegation has taken place, in addition two (2) out of four (4) staff and resident one (R1) have indicated that R1 does receive M1 per physician's order. Record reviews revealed the following: R1's Medication Administration Records (MAR) indicate that M1 was ordered on 04/15/24 and that it is to be provided as needed(PRN) only, not on a nightly basis. R1's LIC602A, dated 12/29/22, indicates: R1 can "manage own treatment, medication, and equipment", is "able to follow instructions" and is "able to communicate needs". Furthermore, CCLD staff researched M1 via webmd.com. Research revealed that M1 "may sometimes cause addiction. This risk may be higher if you have a substance use disorder." Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation that "Staff wrongfully evicted resident in care." it has been alleged that the facility does not provide thirty (30) days to residents during eviction. Interviews revealed that seven (7) out of seven (7) residents and all four (4) staff have denied the allegation has taken place. During this investigation, CCLD staff observed R1 is present at the facility. Record reviews indicates that there have been requests to collect missed payments from R1, but that no eviction notice has been issued. Based on the department’s record reviews, CCLD staff’s observations and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been no deficiencies cited during today's visit.

An exit interview was held with Maria Clarizze Punit, Administrator (S1) and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

LIC9099 (FAS) - (06/04)

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