197608888-7-6-2023-11-AS-JHAD-CUWVP9-20230821163622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 07/06/2023
Date Signed: 07/06/2023 04:18:48 PM

Unsubstantiated

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
06/26/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230626080823

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: 68	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Melissa Christopher & Robin Owens		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.
Staff are not providing resident P&I monies.
Staff do not assist residents timely.

INVESTIGATION FINDINGS:

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On 07/06/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA was greeted by Administrator Melissa Christopher. LPA explained the purpose of the visit is to investigate the allegations mentioned above.

The investigation revealed the following: Interviews with staff #1-#6 (S1-S6), a review of (R1's) physicians report, Resident Financial Statement, Resident Fund Management Service, Resident Personal Inventory List, and other pertinent documents associated with this complaint. A review of staff and resident rosters. A tour of the facility was conducted.

(Evaluation Report continues on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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-20230626080823

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: 07/06/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not safeguard the resident's personal belongings.
The details for the complaint alleged facility failed to safeguard resident #1 (R1's) personal belongings. The Department reached out to the reporting party and was not able to provide further details on the matter.

An interview with (R1) claimed to be a resident of the community for four (4) years. (R1) stated when admitted for a brief time at a skilled nursing facility for several weeks in 2022, the staff failed to safe guard (R1's) 40" television and a suitcase filled with clothing. According to (R1) the staff made space for a roommate to share room #329 and had removed a suitcase and placed the suitcase in a gated storage in the basement of the building. (R1) stated when (R1) obtained the suitcase was empty and all the clothing disappeared. (R1) admitted making personal arrangements with a former resident witness #1 (W1) and gave the 40" television. When (W1) moved out of the community several months ago, the resident had taken the television set. (R1) felt the staff is responsible for safeguarding the television, and the facility should have notified (R1) that (W1) had vacated. Interviews with staff #1-#2 (S1-S2) reported that (R1) made personal arrangements with (W1) that did not involve the administration staff. (S1-S2) was unaware if money transaction was involved. (S1-S2) stated (R1) did not have anything in writing or proof of purchase as a receipt between (R1) and (W1). Interviews with staff (S5-S6) acknowledge that (R1) did have a television set and had given the former resident ownership of the television set. (S1-S2) denied (R1) having any personal items stored in the basement for (R1). Interviews conducted by residents #2-#6 (R2-R6) reported having no issues or concerns concerning the safe keeping of personal belongings. A review of (R1's) Personal Inventory List acknowledged by (R1) dated 01/13/20 did not include a suitcase or television set. The former resident witness #1 (W1) was not available for an interview.

Allegation: Staff are not providing resident P&I monies.
The details for the complaint alleged facility failed to provide resident #1 (R1's) personal funds. The Department reached out to the reporting party and was not able to provide further details on the matter.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230626080823

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: 07/06/2023

NARRATIVE

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Interview with (R1) who stated being responsible for handling finances. (R1) financial income included SSA and SSI and that (R1) was the payee. Staff #4 (S4) claimed, effective 03/22/23, (R1) signed an authorization and agreement for the facility to handle (R1's) funds. Prior to 03/22/23, (R1) was receiving SSA and SSI income through (R1's) personal bank account. According to (R1's) Resident Financial Statement, (R1) has credit balance of $320.02 of P&I. (R1) was unaware that P&I funds are distribute to residents when requested. Staff #3 (S3) is responsible for distributing resident's P&I funds stated (R1) has not requested for funds since the facility took over the handling of financial affairs for (R1). (R1) stated not being aware that P&I funds were available and needed to be requested as (R1) has not attended any of the Resident's Council Meetings. (R1) stated that it is all a misunderstanding and did not fault the management for holding on to the available funds. Family members or conservators handled residents' funds, so no issues or concerns were reported during interviews with residents #2-#6 (R2-R6).

Allegation: Staff do not assist residents timely.
It is alleged the facility failed to assist resident #1 (R1) promptly when the call button is activated. The Department reached out to the reporting party and was not able to provide further details on the matter.

(R1) stated that the call button in room #329 is operable. (R1) stated it was last activated on 07/05/23 and that staff responded within 5-6 minutes. (R1) stated although independent, there was an incident about a year ago when staff did not respond to a call for 45 minutes. (R1) could not call the date, time, and name of the staff on duty. (R1) reported the response time is now acceptable and did not have any issues with (R1's) care or supervision. (S2) stated having the following on staff for each shift: (5) caregivers, (2) med-tech for the morning shift; (6) caregivers, (2) med-techs for the evening shift, and (3) caregivers, (1) med-tech for the NOC shift. Interviews with residents #2-#6 (R2-R6) had no issues with their call buttons and stated response from staff is timely within 5-10 minutes. (R2-R6) were complimentary of the staff and stated the care and supervision are commendable.

Based on information gathered, an inspection of the facility, observation, and interviews conducted, documents reviewed, and no demonstrative evidence provided by the complainant, the Department found no evidence to support the allegations mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230626080823

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: 07/06/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview conducted with Robin Owens and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

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