197608888-5-30-2024-11-AS-UCOL-D5VM5Q-20240603091839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 04/03/2024
Date Signed: 05/30/2024 03:39:47 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
03/28/2024 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240328161608

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: 95	DATE:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Robin Owens, Wellness Director		TIME COMPLETED:	05:04 PM

ALLEGATION(S):

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Facility does not have an Administrator.
Licensee does not follow proper admission procedures with residents in care.
Licensee is not ensuring that there are enough staff to meet the needs of residents in care.

INVESTIGATION FINDINGS:

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On 05/30/24 Licensing Program Analyst (LPA) Mario Leon conducted a follow-up, unanounced, visit to the above-mentioned facility to deliver this amended document. LPA was met by Robin Owens, Wellness Director (S1) and later by Azucena Reyes, Social Worker (S8) and Meshulem "Michael" Weiss (S9).

The investigation consisted of the following:
On 05/30/24 Licensing Program Analyst (LPA) Mario Leon was provided an additional LIC308 and LIC501 for Meshulem "Michael" Weiss (S9). On 04/03/24 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Robin Owens, Wellness Director (S1) and the purpose of the visit was explained. S1 and LPA toured the facility. LPA was later met by Maria Clarizze B. Punit, Interim Administrator (S2). LPA interviewed seven (7) out of ninety-five (95) residents and 7 out of forty (40) staff.

Report Continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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-20240328161608

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: 04/03/2024

NARRATIVE

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The investigation revealed the following:
Regarding the allegation: "Facility does not have an Administrator.". It has been alleged that there is no licensed administrator at the facility.
Interviews revealed that six (6) out of 7 staff and four (4) out of 7 residents have denied the allegation.
Record reviews revealed that the facility manager, Meshulem "Michael" Weiss (S9), was indicated on the LIC308 - Designation of Facility Responsibility as a designated substitute, who has the qualifications adequate to be responsible and accountable for management and administration of the facility as specified in regulation 87405. On 04/03/24, S2 was present at the above-mentioned facility and had been placed on the LIC308 - Designation of Facility Responsibility and that the facility. S2 will be informing the state licensing agency regarding the change of authorization on or before Friday 04/05/24, which is within the ten-day reporting requirement period of the change in authorization. LPA reviewed S2’s staff records. Record Reviews indicate S2’s application for Administrator certificate as pending.
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: "Licensee does not follow proper admission procedures with residents in care.". It has been alleged that there has been fifty (50) new residents within the past two months.
Interviews revealed that 6 out of 7 staff and five (5) out of 7 residents have denied the allegation.
Record reviews revealed that there were twenty-eight (28) residents admitted between the months of February and March. LPA also reviewed each individual’s recent medical assessment from each residents’ Physician. The facility was also able to provide pre-admission appraisal forms for the previously mentioned residents, which verifies the status of resident admissions are appropriately followed.
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: "Licensee is not ensuring that there are enough staff to meet the needs of residents in care.". It has been alleged that the facility has not kept up on proper staffing with all of these new (50)
residents.
Report continues, see LIC9099C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240328161608

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: 04/03/2024

NARRATIVE

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Interviews revealed that 5 out of 7 staff and all 7 residents have denied the allegation. Through interviews conducted, there are between 4 and 5 caretakers during each shift.
LPA requested staffing updates and LPA was provided a staff roster of February and March. Record reviews revealed that there are 40 staff, twenty (20) of which are caretakers and 7 of which are med-techs. After reviewing these numbers, it has been calculated that the ratio of staff to residents has been sufficient to provide care to the residents during the months of February and March.
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.

An exit interview was conducted with Meshulem "Michael" Weiss (S9), and a copy of this report has been provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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