197608888-9-25-2025-11-AS-SCIS-DMC389-20251010180110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 09/25/2025
Date Signed: 09/25/2025 03:00:43 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
09/16/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250916161714

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: 88	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	11:23 AM
MET WITH:	Azucena Reyes		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff mismanage residents' medications.
Staff do not have appropriate interactions with residents.
Staff do not ensure that the facility is free of pests.

INVESTIGATION FINDINGS:

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On 09/25/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to further investigate the above-mentioned allegations. LPA met with Azucena Reyes, Administrator, and the purpose of the visit was explained. LPA was granted access to the facility.

The investigation consisted of the following: On 09/24/25, LPA Gonzalez conducted interviews with staff #1-#5 (S1-S5), and residents #1-#8 (R1-R8). LPA requested and reviewed the staff roster, resident roster, and pest control receipts from Excel Pest Management for the months of August and September 2025. LPA reviewed resident service files for R1-R3, and requested the following documents: Face Sheet, Physician's Report, Needs and Services Plan, and Medication Administration Record (MAR) for the months of August and September 2025. On 09/25/25, LPA Gonzalez conducted an interview with staff #6 (S6). Additionally, LPA Gonzalez conducted a tour of the facility with Azucena Reyes, and inspected the medication room, common areas, and rooms #231, #203, #307, and #312.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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-20250916161714

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: 09/25/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff mismanage residents medications. It is being alleged that staff rush the residents when administering their medications, and that residents have gone days without their medications. It is also being alleged that staff does not administer pain medication in a timely manner. On 09/24/25, LPA Gonzalez interviewed S1-S5, and on 09/25/25, LPA Gonzalez interviewed S6. Of those interviewed, 4 out of 6 staff denied the allegation, and 2 out of 6 staff said they did not know if staff mismanage residents medication. 4 out of 6 staff stated that staff are administering the residents medication on time and as prescribed by their physician, and 2 out of 6 staff said they did not know if staff are administering the residents medication on time and as prescribed by their physician.

On 09/24/25, LPA Gonzalez interviewed R1-R9. Of those interviewed, 6 out of 8 residents could not corroborate with the allegation, and 2 out of 8 residents said that staff has mismanaged their medication. 6 out of 8 residents said that staff administer their medication on time and as prescribed, and 2 out of 8 residents said that staff does not administer their medication on time and as prescribed. 7 out of 8 residents said they have not gone days without their medication, and 1 out of 8 residents said they have not received several of their medications in over a month.

On 09/25/25, LPA Gonzalez conducted a review of the MAR’s for the months of August, and September 2025 for R1-R3 and observed them to be in order and did not observe any discrepancies.

Based on LPA observations, a review of records, 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.

Allegation: Staff do not have appropriate interactions with residents. It is being alleged that facility staff are rude to the residents. On 09/24/25, LPA Gonzalez interviewed S1-S5, and on 09/25/25, LPA Gonzalez interviewed S6. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they treat all residents with dignity and respect.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250916161714

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: 09/25/2025

NARRATIVE

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On 09/24/25, LPA Gonzalez interviewed R1-R8. Of those interviewed, 8 out of 8 residents denied the allegation. 8 out of 8 residents said staff treat them with dignity and respect.

Based on LPA observation, 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.

Allegation: Staff do not ensure that the facility is free of pests. It is being alleged that the facility has roaches. On 09/24/25, LPA Gonzalez interviewed S1-S5, and on 09/25/25, LPA Gonzalez interviewed S6. Of those interviewed, 6 out of 6 staff denied the allegation. S1 stated that they ensure the facility is free of pests by addressing it immediately, and that they have a pest control company come to treat and spray the facility twice a month.

On 09/24/25, LPA Gonzalez interviewed R1-R8. Of those interviewed, 8 out of 8 residents denied the allegation. 8 out of 8 residents said they have not encountered any roaches in the facility. 8 out of 8 residents said that staff has pest control treat the facility regularly. 8 out of 8 residents stated that the facility is kept clean and sanitary.

On 09/25/25, LPA Gonzalez toured the facility and inspected rooms #231, and #203 on the second floor, and rooms #307, and #312 on the third floor. LPA observed the facility and the rooms to be clean, sanitary, and free of roaches. Additionally, LPA Gonzalez reviewed pest control service invoices for the months of August and September 2025 from Excel Pest Management and observed that the company has come to the facility twice per month for general pest control services, to target ants, cockroaches, crickets, earwigs, general pests, silverfish, and spiders.

Based on LPA observations 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.

No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Azucena Reyes, Administrator.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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