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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 04/12/2024
Date Signed: 04/12/2024 02:40:31 PM

Substantiated


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 Elvira Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240328112304
FACILITY NAME:WEST PICO TERRACE ASSISTED LIVING CENTER LPFACILITY NUMBER:
197608888
ADMINISTRATOR:CHRISTOPHER,MELISSAFACILITY TYPE:
740
ADDRESS:6050 W PICO BLVDTELEPHONE:
(323) 653-5565
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:136CENSUS: 95DATE:
04/12/2024
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Azucena Reyes TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility staff failed to properly address bed bugs in the facilitty.
Facility is failing to provide a safe means of evacuating resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to this facility to deliver the complaint findings. LPA met with Azucena Reyes, Social Worker and explained the purpose of today's visit.

The investigation consisted of the following: During the initial visit conducted on 04/04/24, LPA Gonzalez requested, and received the following documents: Staff and Resident Rosters, Pest Control Work orders dated 09/09/23, 09/22/23, 11/11/23 and 03/29/24, and Fire Drill Reports dated 01/17/24, 02/22/24, and 03/24/24. LPA Gonzalez along with Social Worker Azucena Reyes, toured the facilities emergency exits, and inspected rooms 203, 204, 207 on the 2nd floor, and rooms 312, 314, and 334 on the 3rd floor. LPA Gonzalez interviewed residents R1-R9 and staff S1-S7.


Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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 5
Control Number 11-AS-20240328112304
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: 04/12/2024
NARRATIVE
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The Investigation revealed the following:
Regarding the allegation: Facility staff failed to properly address bed bugs in the facility. It is alleged that the facility has a bed bug infestation in rooms #321, #312 and #314 and some other rooms on the third floor. On 04/04/24 LPA Gonzalez and Social Worker Azucena Reyes toured the facility and inspected rooms #203, #204, #207 on the 2nd floor and rooms #312, #314, #334 on the 3rd floor. LPA Gonzalez found all rooms to be clean and free of any bed bugs. On 04/04/24 LPA Gonzalez assessed the Pest Control Work Order dated 03/29/24. Per interview with Social Worker Azucena Reyes, the resident in room #312 reported bed bugs in their room. Per pest control work orders, pest control was contacted on 03/22/24 and came by to treat the facility on 03/29/24. Per pest control work order, the following rooms were inspected: on the second floor rooms #201 - #212, #214 - #230, and #232 - #234. On the third floor rooms #301 - #305, #307 - #312, #314 - #331, #333 - #335, break room, kitchen, and the laundry room. Inspection revealed a heavy live bed bug infestation found in rooms #225 and #312. Terminix Commercial came in to the facility on 04/12/24 for a follow up service appointment.

On 04/12/24 LPA Gonzalez interviewed two Terminix Commercial (pest control company) employees (W1-W2). W1 stated that Terminix came out to treat the facility on 03/29/24 for general pest control services. W1 stated that the facility has a 12-month bi-weekly agreement with Terminix. The treatment plan that they have with the facility is for general pest control treatment only, which does include treatment for bed bugs. W2 alos stated that Terminix came out to treat facility on 03/29/24 for general pest control services. W2 reported that live bed bugs were found in rooms #225 and #312 and treated by Terminix technician on 03/29/24. W2 also confirmed that the treatment plan with the facility does not include treatment for bed bugs.

On 04/04/24 LPA Gonzalez interviewed 7 staff members. When LPA Gonzalez asked staff if there was currently a bed bug infestation in this facility, 6 out of 7 staff stated that there is not a bed bug infestation in this facility. When LPA asked staff if a pest control company would come out to treat the facility, 7 out of 7 staff stated that a pest control company had come to treat the facility on 03/29/24.

On 04/04/24 LPA Gonzalez interviewed 9 residents. LPA Gonzalez asked residents if there’s been any issues with a bed bug infestation in this facility. 3 out of 9 residents interviewed stated there is a bed bug infestation in this facility. When LPA Gonzalez asked residents if they like living in this facility 7 out 9 residents interviewed stated they are very comfortable and like living in this facility. When LPA asked residents how they felt about the overall cleanliness of the facility, 7 out of 9 residents interviewed stated that it’s ok, and they like it.

Continued on LIC9099-C
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240328112304
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: 04/12/2024
NARRATIVE
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Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.


Regarding the allegation: Facility is failing to provide a safe means of evacuating resident. It is alleged that there are non-ambulatory residents in room(s) on the 3rd floor of the facility. There is a concern that in case of an emergency it would be hard for residents to evacuate the facility.

On 04/04/24 LPA Gonzalez interviewed 7 (S1-S7). LPA Gonzalez asked if they (staff) feel that they are trained on the emergency evacuation plan, 6 out of 7 staff interviewed stated that they feel they are trained in the facilities emergency evacuation plan. On 04/04/24 LPA Gonzalez interviewed 9 residents (R1-R9). LPA Gonzalez asked if they feel that this facility is prepared and ready to assist residents to evacuate safely if an emergency were to occur. 5 out of 9 residents interviewed stated that they feel the facility is prepared and ready to assist residents to evacuate safely if an emergency were to occur. When LPA Gonzalez asked residents if the facility conducts emergency evacuation drills, 6 out of 9 residents interviewed said that the facility does not conduct emergency evacuation drills.

On 04/04/24 records reviewed revealed the facility has a fire clearance (dated: 03/21/23) for a capacity of 136 non-ambulatory residents. LPA Elvira Gonzalez assessed the Disaster Drill Reports received, which states that an emergency evacuation drill was practiced on the following dates: 01/17/24, 02/22/24, and on 03/24/24.

Furthermore, on 04/04/24 LPA Gonzalez toured the facility focusing on the facilities emergency stairwell exits. LPA Gonzalez did not observe an evacuation chair at each stairwell. Each floor has 2 stairwell emergency exits, 2 on the 2nd floor and 2 on the 3rd floor. LPA Gonzalez observed the 3rd floor stairwells had emergency evacuation chairs on both stairwells, and the 2nd floor did not have emergency evacuation chairs at either of the 2 stairwell exits.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

Continued on LIC9099-C

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240328112304
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: 04/12/2024
NARRATIVE
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Deficiencies are being cited based on LPA interviews, observations, and records review in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted, plans of corrections were reviewed and developed. A copy of this report and appeal rights left with Azucena Reyes, Social Worker.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240328112304
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2024
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The licensee did not comply with the section cited above in staff stating that bed bugs were reported in room #312, and were treated by Terminix Commercial on 03/29/24. Although they were treated, it did not give proper treatment for bed bugs as there should be continuous treatment for bed bugs, not just one spray. This poses a potential Health, Safety or Personal rights risk to residents in care.
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Licensee will ensure that bed bug activity in the facility is eradicated. Licensee will provide LPA with a copy of Pest Elimination Service Plan for bed bugs, along with invoice via email to Elvira.Gonzalez@dss.ca.gov
Type B
05/03/2024
Section Cited
HSC
159.695(f)(1)
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(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019.
Based on observation, the licensee did not comply with the section cited above in not having an evacuation chair in each stairwell. Which poses a potential health, safety or personal rights risk to persons in care.
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Licensee will place an evacuation chair at each stairwell and email proof of corrections to Elvira.Gonzalez@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5