197608888-5-21-2025-11-AS-RORN-DH4KNP-20250528080325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 05/21/2025
Date Signed: 05/21/2025 04:29:40 PM

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
05/01/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250501092104

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: 86	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	03:12 PM
MET WITH:	Azucena Reyes		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff did not ensure resident’s personal information remained confidential.
Administrator is not responsive to resident’s request for communication.

INVESTIGATION FINDINGS:

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**This report supersedes the report created and delivered on 05/07/25. This report is to clarify findings.

On 05/07/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the above-mentioned allegations. LPA met with Administrator, Azucena Reyes, and the purpose of the visit was explained. LPA was granted access to the facility.

The investigation consisted of the following: On 05/07/25, LPA requested the staff and resident rosters. LPA reviewed resident files, and requested copies of: Admission Agreement, Admission Record, Needs and Services Plan, and Personal Rights for resident #1 (R1). Additionally, LPA conducted interviews with staff #1-#5 (S1-S5) and residents #1-#8 (R1-R8).

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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-20250501092104

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: 05/21/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not ensure resident’s personal information remained confidential. It is being alleged that a staff member asked a resident for confidential information such as bank information and Social Security Number (SSN). Now the resident is receiving multiple calls regarding a loan, and/or the callers attempting to get additional personal information from the resident. On 05/07/25, between 12:30 PM and 1:40 PM, LPA interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that the facility ensures that all residents personal information remains confidential. 5 out of 5 staff interviewed stated that they don’t know of a staff member that used a resident’s personal information for personal use and or fraud. 5 out of 5 staff interviewed stated that all residents are treated with dignity and respect.

On 05/07/25, between 1:45 PM and 3:05 PM, LPA interviewed R1-R8. Based on interviews conducted, 7 out of 8 residents interviewed stated that staff does ensure that resident’s personal information remains confidential. 7 out of 8 residents interviewed stated that they don’t know of a staff member that used a resident’s personal information for personal use and or fraudulent purposes. 7 out of 8 residents interviewed stated that staff treat them with dignity and respect. 7 out of 8 residents interviewed stated that they are satisfied with the services being provided to them.

Based on interviews, file review and observation during the investigation, the above allegation is found to be Unsubstantiated. 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.

Allegation: Administrator is not responsive to resident’s request for communication. It is being alleged that staff is always busy and never wants to talk to a resident. On 05/07/25, between 12:30 PM and 1:40 PM, LPA interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that staff responds to resident’s requests for communication.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250501092104

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: 05/21/2025

NARRATIVE

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2 out of 5 staff interviewed stated that they have not ignored a resident’s request for communication, and 3 out of 5 staff interviewed stated they did not know of staff ignoring a resident’s request for communication. 5 out of 5 staff interviewed stated that all residents are treated with dignity and respect. An interview conducted with S1 revealed that they have an open-door policy, and that the residents can come talk with them whenever they want. S1 stated that if they are busy when the resident requests to speak with them, they will let the resident know they are busy, and to either come back at a later time, or they will go to the resident when they are done and available.

On 05/07/25, between 1:45 PM and 3:05 PM, LPA interviewed R1-R8. Based on interviews conducted, 7 out of 8 residents interviewed denied the allegation. 7 out of 8 residents interviewed stated that staff responds to resident’s requests for communication. 7 out of 8 residents interviewed stated that they did not know of staff ignoring a resident’s request for communication. 7 out of 8 residents interviewed stated that they are treated with dignity and respect. 7 out of 8 residents interviewed stated that they are satisfied with the services being provided to them.

Based on interviews, file review and observation during the investigation, the above allegation is found to be Unsubstantiated. 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.

No deficiencies were cited during this investigation.

An exit interview was conducted with Administrator, Azucena Reyes, and a copy of the report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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