197608888-8-18-2023-11-AS-MVAO-CWXP7R-20231025110421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 08/18/2023
Date Signed: 08/18/2023 01:57:31 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
07/05/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230705160848

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:	08/18/2023
		UNANNOUNCED	TIME BEGAN:	12:14 PM
MET WITH:	Robin Owens		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff do not provide medication as prescribed.
Staff yells at resident(s) in care.
Staff do not provide adequate food service.
Staff is rough with residents in care.
Staff not able to communicate with residents.
Staff not meeting resident incontinence needs.

INVESTIGATION FINDINGS:

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On 07/13/23, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced 10-day complaint visit at this facility, LPA was greeted by Robin Owens, Health, and Wellness Director. LPA explained the purpose of today's visit was to gather information about the above allegations.

The investigation consisted of the following:

LPA obtained copies of the staff and resident rosters, medical administration records, and admission records for residents R1-R7. LPA interviewed staff and residents.

The investigation revealed the following: Regarding allegation #1: Staff do not provide medication as prescribed.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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 3

Control Number 11-AS-20230705160848

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: 08/18/2023

NARRATIVE

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On 07/13/23, LPA interviewed S1-S4. 4 of 4 staff denied the allegation that Staff do not provide medication as prescribed. All staff confirmed that the resident’s medication is never late. Additionally, 5 of 7 residents interviewed, denied the allegation Staff do not provide medication as prescribed.

Based on interviews, and records reviewed there is insufficient evidence to support the allegation: Staff do not provide medication as prescribed. 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, therefore the allegation is Unsubstantiated.

Allegation #2: Staff yells at resident(s) in care.

On 07/13/23, LPA interviewed S1-S4. 4 of 4 staff denied the allegation Staff yells at resident(s) in care. All staff confirm that no one yells at the residents. Additionally, 5 of 7 residents interviewed, denied the allegation Staff yells at resident(s) in care.

Based on interviews there is insufficient evidence to support the allegation: Staff yells at resident(s) in care. 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, therefore the allegation is Unsubstantiated.

Allegation #3: Staff do not provide adequate food service.

On 07/13/23, LPA interviewed S1-S4. 4 of 4 staff denied the allegation Staff do not provide adequate food service. All staff confirm that adequate food service is being provided and no one misses any meals. Additionally, 7 of 7 residents interviewed, denied the allegation Staff do not provide adequate food service.

Based on interviews, there is insufficient evidence to support the allegation: Staff do not provide adequate food service. 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, therefore the allegation is Unsubstantiated.

Allegation #4: Staff is rough with residents in care.

On 07/13/23, LPA interviewed S1-S4. 3 of 4 staff denied the allegation Staff is rough with residents in care. Additionally, 4 of 7 residents interviewed, denied the allegation Staff is rough with residents in care.

Based on interviews, there is insufficient evidence to support the allegation: Staff is rough with residents in care. 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, therefore the allegation is Unsubstantiated.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230705160848

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: 08/18/2023

NARRATIVE

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Allegation #5: Staff not able to communicate with residents.

On 07/13/23, LPA interviewed S1-S4. 4 of 4 staff denied the allegation Staff not able to communicate with residents. All staff confirm that they can communicate with all the residents effectively. Additionally, 7 of 7 residents interviewed, denied the allegation Staff not able to communicate with residents. They all confirm that they can communicate with the residents.

Based on interviews, there is insufficient evidence to support the allegation: Staff not able to communicate with residents. 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, therefore the allegation is Unsubstantiated.

Allegation #6: Staff not meeting resident incontinence needs.

On 07/13/23, LPA interviewed S1-S4. 4 of 4 staff denied the allegation Staff not meeting resident incontinence needs. All staff confirm that when incontinence items are low, they place appropriate calls or let management know to order more supplies for the residents. Additionally, 7 of 7 residents interviewed, denied the allegation Staff not meeting resident incontinence needs. 3 of the 7 residents were not incontinent and therefore does not need incontinence items.

Based on interviews, there is insufficient evidence to support the allegation: Staff not meeting resident incontinence needs. 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, therefore the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a hard copy of this report was provided to Robin Owens, Health, and Wellness Director.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC9099 (FAS) - (06/04)

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