197608888-4-19-2024-11-AS-UCOL-D4MT5C-20240424142518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 03/21/2024
Date Signed: 04/19/2024 09:39:28 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, 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
03/13/2024 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240313150846

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: 96	DATE:	03/21/2024
		UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Administrator Aaron Mayes		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff do not ensure that resident has access to clean clothing.
Staff do not ensure that resident's incontinence needs are being met.
Staff do not ensure that resident's hygiene needs are being met.
Staff do not ensure that resident is provided with an adequate amount of food and water.
Staff are not adequately supervising resident.

INVESTIGATION FINDINGS:

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The purpose of the amendment is to provide additional information and it does not change the investigation findings. On 03/21/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Health and Wellness Director Robin Owens and explained the purpose of the visit. Administrator Aaron Mayes joined us shortly after.

The investigation consisted of the following: During today’s investigation, LPA interviewed 8 out of 96 residents, 7 staff which included the Administrator, Health and Wellness Director, (2) MedTech, Laundry and (2) Caregivers, and outside Case Worker. LPA also reviewed the resident records.

Continue to LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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 4

Control Number 11-AS-20240313150846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 03/21/2024

NARRATIVE

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Allegation(s):

Staff do not ensure that resident has access to clean clothing.

The investigation revealed the following: Regarding the allegation " Staff do not ensure that resident has access to clean clothing,” it is being alleged that R1 is wearing the same soiled clothes. Interviews conducted indicate the following: laundry services are provided once per week and residents have the right to refuse services. Residents can also request for the additional clothes donated to the facility. LPA Cloyd observed R1’s clothing to be very stained with food. LPA toured R1's room and saw three shirts, one long jean jacket and hoodie, and four folded clothing items in R1's closet. R1 stated that R1 does receive laundry services. Administrator stated that R1 gets angry when prompted to wash clothing and refuses weekly services but will allow biweekly laundry services. Record review indicates that R1 is able to dress/groom self. Based on the interviews, observation, and record reviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Allegation(s):

Staff do not ensure that resident's incontinence needs are being met.

The investigation revealed the following: Regarding the allegation "Staff do not ensure that resident's incontinence needs are being met,” it is being alleged that R1 has frequent incontinence issues, does not appear to be having regular support with urinary incontinence, and arrives with no adult diapers. Interviews conducted indicate the following: staff conduct rounds and complete incontinence changes, residents have access to a call button to request incontinence changes, residents may refuse services, and supplies are ordered through insurance. LPA Cloyd did not observed R1 to have incontinence needs. R1 stated that R1 can help self. Record review indicates that R1 does not have incontinence issues. Based on the interviews, observation, and record reviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Continue to LIC809-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240313150846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 03/21/2024

NARRATIVE

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Allegation(s):

Staff do not ensure that resident's hygiene needs are being met.

The investigation revealed the following: Regarding the allegation "Staff do not ensure that resident's hygiene needs are being met,” it is being alleged that R1 does not appear to be bathing regularly. Interviews conducted indicate the following: staff conduct rounds and completes shower schedules and residents may refuse shower assistance. R1 stated that R1 can shower self. Record review indicates that R1 does not need showering assistance. Based on the interviews, observation, and record reviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Allegation(s):

Staff do not ensure that resident is provided with an adequate amount of food and water.

The investigation revealed the following: Regarding the allegation " Staff do not ensure that resident is provided with an adequate amount of food and water,” it is being alleged that R1 frequently asking for coffee/water upon first arriving. Interviews conducted indicate the following: three meals and snacks are offered to the residents, meals can be delivered upon request, and residents may refuse food. R1 stated that R1 does not eat much, does not have to take the food, and will just have coffee. Record review indicates that R1 does not have a special diet and is able to follow directions. Based on the interviews, observation, and record reviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Continue to LIC809-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240313150846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 03/21/2024

NARRATIVE

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Allegation(s):

Staff are not adequately supervising resident.

The investigation revealed the following: Regarding the allegation "Staff are not adequately supervising resident,” it is being alleged that R1 walks into the place of business without being escorted/dropped off. Interviews conducted indicate the following: staff and office communicates when a resident leaves the facility and residents are responsible for signing in and out of the facility. R1 stated that the facility said R1 could not leave but R1 leaves anyways. Record review indicates that R1 can leave the facility without assistance. Based on the interviews, and record reviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was left with Health and Wellness Director Robin Owens.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC9099 (FAS) - (06/04)

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