197608888-8-28-2025-11-AS-SCIS-DM4UPZ-20251003154622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 08/28/2025
Date Signed: 08/28/2025 10:14:02 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
08/20/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250820101821

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: 93	DATE:	08/28/2025
		UNANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Azucena Reyes		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not safeguard a resident's personal belongings.
Staff did not prevent a resident from biting another resident.
Staff did not respond timely to a resident's alerts.

INVESTIGATION FINDINGS:

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On 08/28/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint report to investigate the allegations listed above. 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 08/27/25, LPA conducted interviews with staff #1-#4 (S1-S4), residents #1-#10 (R1-R10) and attempted to interview resident #11 (R11). LPA received the following documents: staff roster, and resident roster. Additional documents received via email, which included an Unusual Incident/Injury Report (dated: 05/19/25), client progress notes (dated: 05/19/25, and 06/23/25). Furthermore, LPA and Azucena Reyes toured the facility, and inspected resident rooms, and common areas.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

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 4

Control Number 11-AS-20250820101821

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: 08/28/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not safeguard a resident's personal belongings. It is being alleged that there have been various incidents regarding theft. On 08/27/25, between 11:00 AM and 12:00 PM, LPA Gonzalez conducted interviews with S1-S4. Of those interviewed, 4 out of 4 staff could not corroborate with the allegation. 3 out 4 staff stated that there hasn’t been any complaints or concerns regarding any residents missing any items. S1 stated that residents have raised concerns involving a certain resident taking other residents personal belongings. S1 stated that they have talked to that resident and are investigating the matter. S1 also stated that in the event that a resident was to have a complaint regarding a missing item, the facility has a theft and loss that the resident will fill out. S1 stated that facility staff will conduct a thorough search for the item, and if the item isn’t found, the facility will then replace that item or provide a reimbursement.

On 08/27/25, between 1:10 PM and 3:20 PM, LPA Gonzalez conducted interviews with R1-R10 and attempted to interview R11, but was unable to as R11 was out in the community. Of those interviewed, 9 out of 10 residents could not corroborate with the allegation. 9 out of 10 residents stated that they have no complaints regarding any missing or stolen personal items. 10 out of 10 residents said they are satisfied with the services provided to them at the facility.

Based on record review, interviews, and observations, 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.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250820101821

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: 08/28/2025

NARRATIVE

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Allegation: Staff did not prevent a resident from biting another resident. It is being alleged that a resident was bitten by another resident. On 08/27/25, between 11:00 AM and 12:00 PM, LPA Gonzalez conducted interviews with S1-S4. Of those interviewed, 4 out of 4 staff denied the allegation. 4 out of 4 staff said they maintain a safe and healthy environment for the residents within the facility. S1 stated that there was a resident who first reported that they had smashed their finger with the door but then said another resident bit them the next day. S1 stated staffed assessed the resident’s finger and they did not observe the wound to appear like a bite mark but rather a small tear.

On 08/27/25, between 1:10 PM and 3:20 PM, LPA Gonzalez conducted interviews with R1-R10 and attempted to interview R11, but was unable to as R11 was out in the community. Of those interviewed, 10 out of 10 residents did not know of an incident involving a resident biting another resident. 10 out of 10 residents said they feel safe in this facility. 10 out of 10 residents said staff maintain a safe and healthy environment for them within the facility.

On 08/28/25, LPA Gonzalez conducted a record review of an Unusual Incident/Injury Report (dated: 05/19/25) which revealed that on 05/17/25, R11 reported that they hurt their finger when opening the room door and noticed a scratch on finger. Then on 05/18/25, R11 told the med-tech that their roommate bit the same finger while he was sleeping and requested a band aid. Client progress notes (dated: 05/19/25, 09:09) revealed that R11 told the facility’s Wellness Director that their roommate bit their finger while they were sleeping. The Wellness Director called Resident Care Coordinator (RCC) to ask what had happened, and RCC stated that on 05/17/25, R11 told them that they had hurt their finger when opening the room door and that they had observed a scratch on R11’s finger. Client progress notes (dated: 05/19/25 10:11) revealed that staff assessed R11’s finger to clean and put a bandage, and observed that R11 has a small skin tear, on their third finger. Staff then spoke with R11’s roommate and they denied doing anything to R11.

Based on record review, interviews, and observations, 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.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250820101821

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: 08/28/2025

NARRATIVE

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Allegation: Staff did not respond timely to a resident's alerts. It is being alleged that a resident fell and had to call for support after waiting 45 minutes. On 08/27/25, between 11:00 AM and 12:00 PM, LPA Gonzalez conducted interviews with S1-S4. Of those interviewed, 4 out of 4 staff denied the allegations. 4 out of 4 staff stated that they respond to a residents call light requests for between 5-10 minutes. 4 out of 4 staff interviewed said that they are not aware of a resident falling and having to call for support on their own after activating the call light and having to wait 45 minutes.

On 08/27/25, between 01:10 PM and 03:20 PM, LPA Gonzalez conducted interviews with R1-R10 and attempted to interview R11, but was unable to as R11 was out in the community. Of those interviewed, 7 out of 10 residents said staff responds to a resident’s call light in a timely manner, 2 out of 10 residents said that staff does not respond to their call light in a timely manner, and 1 out of 10 residents said they did not know because they have never used the call light in their room.

On 08/28/25, LPA Gonzalez reviewed the Personnel Roster (Dated: 07/01/2025) and observed that there is sufficient staff to meet the needs of the residents. Additionally, on 08/27/25, LPA Gonzalez inspected resident bedrooms #321 and #301 and observed call buttons to be in operable condition. LPA Gonzalez observed Azucena Reyes activate the call light and found that the facility staff responded to both calls within five minutes.

Based on record review, interviews, and observations, 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 during this investigation.

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

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