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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:04:49 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2023 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230724150711
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: 71DATE:
07/26/2023
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Melissa Christopher-AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is not maintained at a comfortable temperature for residents in care
INVESTIGATION FINDINGS:
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On 7/26/2023 LPA Alfonso Iniguez conducted and unannounced complaint visit. LPA Iniguez meet with Melissa Christopher/Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted interviews with: Administrator(A#1), Residents (R#1-R#9), and Staff (S#1-S#7) and AC repair technician. LPA obtained and reviewed: resident’s roster, staff roster, physical tour of facility and 9 resident’s rooms with temperature checks at 10:00AM and 2:00 PM and AC repair company contact information.

Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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-20230724150711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP
FACILITY NUMBER: 197608888
VISIT DATE: 07/26/2023
NARRATIVE
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The details of the complaint alleged that the facility's air conditioning unit was not working.

During the course of the investigation, LPA walked the facility's common areas, AC in those areas was working. The activity room temperature marked (77.1F°) and the hallways (75.1F°). At 10:00 AM, LPA checked 9 residents' rooms and 6 out of 9 residents' rooms; the AC was not working; the general temperature in those rooms was (81.1F°), and the AC vents were not blowing air. At 2:00 PM, LPA re-checked the rooms where the AC vents were not blowing cool air; the overall temperature was (81.1F°), and it never reached above (85.0F°).

During interviews, Facility Administrator Melissa Christopher(A#1) stated that the facility's Air Conditioning Unit is not working correctly. Still, they request an AC repair company to assess and repair the unit. In addition, the administrator told LPA that they would bring fans to the rooms where the AC is not working.

During a phone interview with the AC repair technician (RT) that came on 7/25/2023 to assess the AC unit, he stated that the facility told him the unit had not been working properly since 7/20/23. They will call his company for a repair estimate, and he will come and fix the unit. He told LPA that replacing the broken unit would take him between 1 and 2 hours.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230724150711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP
FACILITY NUMBER: 197608888
VISIT DATE: 07/26/2023
NARRATIVE
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During interviews with residents (R#1- R#9), 6 out of 9 stated that the AC unit in their room was not working for a few days, and they felt the temperature was hot inside; they also said that outside their rooms, the temperature is comfortable.

During interviews with staff (S#1-S#7), 6 out of 7 said the AC unit inside residents' rooms is not working for everyone, and it has been more than 3 weeks since the facility's AC unit is not working correctly.

During this investigation, LPA found sufficient evident to support the above-mentioned allegation.

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.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights were given to Melissa Christopher/Administrator.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230724150711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP
FACILITY NUMBER: 197608888
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2023
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.
This Requirement was not met as evidence by:
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Licensee will ensure the AC unit will be in good repair and will sent proof of repaired AC unit to LPA vai email before POC due date. in addition Licensee will provide fans to the resident's rooms where the AC vents are not blowing cool air.
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Based on interviews, records review, and physical tour, the licensee failed to ensure that the AC unit needed to be fixed throughout the facility. During today's visit, on 7/26/23, LPA toured 9 rooms and noticed the AC vents didn not blow cool air. The AC unit was in disrepair, and LPA did not observe fans in the rooms where AC was not working. Based on the interviews conducted, LPA learned that some of the AC units are inoperable on the side of the building where room #212 is located
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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: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4