197608888-10-1-2025-11-AS-SCIS-DN739F-20251106170301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:41:36 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
09/26/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250926105329

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: 89	DATE:	10/01/2025
		UNANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Azucena Reyes		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff does not ensure facility is maintained in good repair for residents.

INVESTIGATION FINDINGS:

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On 10/01/25, LPA Gonzalez conducted an unannounced complaint visit to investigate the allegation listed above. LPA met with Administrator, Azucena Reyes, and explained the purpose of the visit. LPA was granted access to the facility.

The investigation consisted of the following: on 10/01/25, LPA Gonzalez requested the following documents: staff roster, resident roster, maintenance service records dated 08/11/25 from E.Z. Roth Plumbing Inc, and Facility Service Logs dated 08/10/25-10/01/25. LPA conducted interviews with staff #1-#3 (S1-S), witness #1 (W1), residents #2-#7 (R2-R7), and attempted to interview resident #1 (R1). Additionally, LPA and Azucena Reyes conducted a tour of the facility and inspected rooms #229, #230, #231, and #232.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

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-20250926105329

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: 10/01/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff does not ensure facility is maintained in good repair for residents. It is being alleged that a resident is having water leaks in their room, in the closet ceiling. It is also alleged that this has been going on for the past three years and that the facility has not repaired the issue. On 10/01/25, between 10:30 AM and 11:40 AM, LPA Gonzalez conducted interviews with S1-S3. Of those interviewed, 3 out of 3 staff denied the allegation. S2 said that it was reported to them that there was a water leak in room #231 in August 2025. S2 said that staff immediately went to inspect the room and take care of any repairs needed. S2 said that they decided to open up the closet’s ceiling to see if they found any type of water leaking but had to stop as the residents family member told them to stop with the repair. S2 said that they then had a plumber come and assess the room and the closet, to see if they found any plumbing issues, that might be causing a water leak in this room, but the plumber did not find any issues, or any water leaking at the time of the visit. S2 said that since then, they have been monitoring the room daily to see if there is any signs of water leaking but have not observed any water leaking, damage, or mold.

On 10/01/25, between 11:50 AM and 12:00 PM, LPA Gonzalez conducted an interview with a plumber from E.Z. Roth Plumbing Inc. (W1). W1 told LPA that on 08/11/25 they came to this facility and conducted an inspection and ran tests to see if there was any water leak in room #231 but found no leak. W1 said they went upstairs to the room above room #231 and ran the water in the bathroom for about 15 minutes and still had found no leak. W1 stated that they were very thorough during this inspection and ran all the tests possible. W1 said they also ran the AC to see if there was any water leakage coming from there but found no leak.

On 10/01/25, between 01:00 PM and 2:25 PM, LPA Gonzalez conducted interviews with R2-R7, and attempted to interview R1, but was unable to due to R1’s diagnosis. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. 6 out of 6 residents said they do not have any problems with water leaking in their rooms. 6 out of 6 residents said they feel that this facility is in good repair. 6 out of 6 residents said they are satisfied with their rooms, and this facility.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250926105329

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: 10/01/2025

NARRATIVE

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On 10/01/25, LPA Gonzalez conducted a tour of the facility and inspected rooms #229, #230, #231, and #232. LPA did not observe any water leaking from any of the rooms inspected. LPA did observe that the closet in room #231 was empty, and all the residents clothing was hanging in the restroom. LPA did not observe any major water damage, and/or mold in the closet in room #231. Overall, LPA observed the facility to be clean, sanitary, and in good condition.

On 10/01/25, LPA Gonzalez conducted a review of records. Of those records reviewed was a service invoice from E.Z Roth Plumbing Inc. dated: 08/11/25, and it revealed that they were following up on a call for a water leak, and that there was no traces of a leak. Additionally, LPA reviewed facility service logs for the following dates: 08/10/25-10/01/25 and revealed that staff has been checking room #231 daily for any water leaks and have not observed any leaks in the room.

Based on observation, record review, and interviews conducted, 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, and a copy of this report was provided to Administrator, Azucena Reyes.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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