197608888-7-2-2026-11-AS-SCIS-DWHUR8-20260731154815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 07/02/2026
Date Signed: 07/02/2026 12:40:25 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
03/30/2026 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260330144401

FACILITY NAME:	WEST PICO TERRACE ASSISTED LIVING CENTER LP		FACILITY NUMBER:	197608888
ADMINISTRATOR:	AZUCENA REYES SERRANO		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:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Azucena Reyes - Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident sustained multiple bruises,due to staff neglect

INVESTIGATION FINDINGS:

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*This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 4/8/26.

On 7/2/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Administrator, Azucena Reyes and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 4/8/26 LPA Shirley reviewed copies of the following records: Staff and Resident roster, Physicians Reports, service plan, incident reports, conducted a tour of the facility. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff- 6(S1 – S6), and Resident -1 – Resident - 6(R1-R6).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260330144401

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: 07/02/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Resident sustained multiple bruises, due to staff neglect

It is alleged that R1 fell down the stairwell in her wheelchair, resulting in R1 sustaining multiple bruises due to staff neglect. R1 was admitted to this facility on 10/11/23 based on chart’s face sheet. Per review of R1’s chart on 7/2/26, and interview with S1 and S4, R1 was not considered a fall risk. On 7/2/26, LPA Shirley called R1’s prior facility, Primrose Post Acute and noted that R1’s 2023 Fall Risk Assessment considered her a high risk for falls. LPA Shirley reviewed R1’s Physician Report dated 3/11/26, R1 has no auditory impairment, no motor impairment/paralysis and R1 uses a wheelchair and able to self-propel. LPA Shirley observed Physician’s report dated 3/11/26, R1 also has no history of unsafe wandering nor elopement. A review of consultation dated 10/18/24 R1 denies suicidal or homicidal ideation. Per interview with S4 on 4/8/26, R1 is able to access all areas of the facility independently. LPA Felisa Shirley requested and reviewed all incident reports from 7/2025 to current and noted that there was one report of R1 falling. On 4/8/26, LPA Shirley reviewed an incident report dated 3/29/26 reporting R1 being sent to the hospital due to an unwitnessed fall. During interviews on 4/8/26, both R2 and R3 observed R1 in her wheelchair near the stairwell of the main floor rolling back and forth. Residents were located on the main floor of this facility, which includes the Activity room, TV, snacks and the smoking patio. R3 yelled and told R1 to watch out you’re going to fall. Both R2 and R3 observed R1 proceed backwards down the stairs. R2 stated that no one pushed R1 she just rolled back on her on. Per incident report dated 3/29/26, R1 was given medical treatment, taken to the hospital and R1’s primary care physician and family were informed of the incident. LPA Shirley called and spoke to W1 and was told that R1 had no fractures, scans cleared, bruising on the left side of her face, eye, neck and forehead.

LPA interviewed staff 1 – staff 6(S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed resident 1 – resident 6(R1 – R6). Of those who interviewed 3 out of 6 denied the allegation, 1 resident confirmed the allegation and 2 were not sure.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Resident sustained multiple bruises, due to staff neglect,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Azucena Reyes.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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