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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 12/19/2024
Date Signed: 01/22/2025 10:00:52 AM

Substantiated


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
12/10/2024 and conducted by Evaluator Sparkle Day
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241210132236
FACILITY NAME:WEST PICO TERRACE ASSISTED LIVING CENTER LPFACILITY NUMBER:
197608888
ADMINISTRATOR:CHRISTOPHER,MELISSAFACILITY TYPE:
740
ADDRESS:6050 W PICO BLVDTELEPHONE:
(323) 653-5565
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:136CENSUS: 73DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Azucena Reyes, Asst AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff do not ensure resident is provided a safe environment.
INVESTIGATION FINDINGS:
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On 12/19/2024 Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced subsequent complaint visit to deliver complaint investigation findings. LPA Sparkle Day met with Azucena Reyes, Asst Administrator and explained the purpose of today’s visit.

The investigation consisted of the following: On 12/10/2024 between 2:30pm and 4:20 pm , LPA Sparkle Day met with Michael Weiss, Administrator of the Skilled facility and spoke with Clarizze Punit, Administrator via phone. LPA requested and received resident roster, staff roster,R#1's Admission Agreement , Medical Assessment, ID and Info sheet, Appraisal and a list of medications. LPA attempted to speak with R#1 and R#2 but they did not answer the door. LPA Day interviewed Staff #1- Staff #5
During todays visit 12/19/24 between 11:15 am and 12:00 pm LPA requested and received the following documents: R#2's Admission Agreement , Medical Assessment, ID and Info sheet, Appraisal and a list of medications and LPA Day interviewed Staff #6.

The investigation revealed the following:


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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-20241210132236
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: 12/19/2024
NARRATIVE
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Allegation: Staff do not ensure residents are provided a safe environment

It is alleged that staff do not ensure residents are provided a safe environment. During this investigation Licensing Program Analyst Sparkle Day interviewed (6) staff. 6 of 6 staff were consistent in their statements that R#1 has been in the facility for 5 years. R#1 and R# 2 have been in an relationship for about 1 1/2 years and share a room. R#1 does not engage with staff anymore without R#2 since the relationship began. When staff attempt to speak with R#1, R#2 states she will not speak without me present even if you call her on the phone. Staff indicate when R#1 is given a bath R#2 has to be present and never leaves her side. Staff also state that they can hear R#2 yelling at R#1 often and when staff go to knock on the door of R#1 and R#2 they are not allowed in. Staff state they can not talk to R#1 without R#2 and when R#2 is around R#1 will not speak.
On 12/10/24 Licensing Program Analyst Sparkle Day attempted to interview R#1 and R#2, however they would not answer the door for interview. On 12/10/24 The facility called the LAPD regarding the personal rights of the matter. The police were able to separate R#1 and R#2 for interview, however R#1 would still not speak. R#2 indicated to the police that he does not trust the staff and will not let R#1 speak with anyone.

Licensing Program Analyst Sparkle Day finds that Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation 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 and a copy of the Report and Appeal Rights were provided to Azucena Reyes, Asst Administrator..
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241210132236
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
87468(b)
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Personal Rights
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature,
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Administrator agrees to Develop a plan that ensures that Resident #1 rights are not violated and All staff shall attend a training on Personal Rights of the residents in care by the POC date. 12/20/2024
A copy of the training logs and development plan will be sent to LPA :Sparkle Day
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This requirement was not met as evidence by: Staff did not ensure a safe and healthful accommodations for resident in care. Which poses a potential health and safety risk to clients in care
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Sparkle.day@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3