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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 10/18/2020
Date Signed: 10/18/2020 12:59:42 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/15/2020 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20200915151817
FACILITY NAME:TERRAZA OF CHEVIOT HILLSFACILITY NUMBER:
197609050
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:3340 SHELBY DRTELEPHONE:
(310) 837-9181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:100CENSUS: 65DATE:
10/18/2020
UNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Gregory BeckerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Food is not of good quality
Staff did not ensure facility is free from insects
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Gregory Becker, the facility administrator.

The investigation consisted of the following: On 09/21/2020 LPA conducted a virtual tour of the facility and video call interviews with the administrator, 10 out of 65 residents and 7 out of 43 staff, The LPA also requested copies of the food service menu, cleaning schedule, updated personnel report (LIC500). LPA also requested copies of residents R2 and R11's Admission Agreements, Identification and Emergency Contact Information, Physician's Reports, Pre-placement appraisals, Reappraisal’s, Needs and Services Plans, Incident reports and internal logs/charts about care provided for residents R2 and R11 . On 10/16/2020 LPA conducted record reviews of the facility, staff and resident records submitted by the administrator on 09/23/2020.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2020
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-20200915151817
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: TERRAZA OF CHEVIOT HILLS
FACILITY NUMBER: 197609050
VISIT DATE: 10/18/2020
NARRATIVE
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The Investigation revealed the following: Regarding the allegation “Food is not of good quality.” On 09/15/202020 the Department received allegations that the cook quit and there is another person who is cooking the food and the food is bad and the facility is serving stale sandwiches and bad food. On 09/21/2020 LPA interviewed 10 out of 65 residents, 9 out of 10 residents interviewed did not have any issues regarding the food quality, On 09/21/2020 resident R8 stated “The food quality has even gotten better, there is variety and they provide us with alternative meals like, salads and sandwiches.” On 09/21/2020 LPA interviewed 7 out of 43 staff. On 09/21/2020 staff S2 stated that “I have been working here for years now and I am assigned during the day to cook and staff S8 is the evening cook. I am now working 12 hour shifts until S8 comes back from being sick.” We have found the complaint allegation unsubstantiated, although the allegation may have happened or is valid; there is not a preponderance of the evidence to prove that the alleged violation occurred.

Regarding the allegation “Staff did not ensure facility is free from insects.” On 09/15/2020 the department received an allegation that the staff leaves the doors of the facility open which allows insects to fly all around the facility. On 09/21/2020 LPA conducted a virtual tour of the facility and observed that staff had to manually pull the glass panel doors apart to open and manually pull the glass panel doors together to close it. On 09/21/2020 the Facility Administrator stated that the door has been in disrepair since Wednesday 09/16/2020 and that they were currently waiting on technicians to service the doors. On 10/16/2020 LPA reviewed the invoice submitted by the administrator and observed that the facility’s automated door was serviced on 10/07/2020. On 09/21/2020 LPA interviewed 10 out of 65 residents, 9 out of 10 residents interviewed did not have immediate concerns with insects, resident R8 stated that “Once in a while I would see fruit flies, but it’s because we have been eating in our rooms.” On 09/21/2020 LPA interviewed 7 out of 43 staff. Staff S1 stated that some residents leave the patio doors open in their rooms, which allows insects to come in. On 09/21/2020 staff S6 said that “Since we have been delivering food in their rooms, some of residents drop food on the floor and the gnats appear.” We have found the complaint allegation unsubstantiated, although the allegation may have happened or is valid; there is not a preponderance of the evidence to prove that the alleged violation occurred.

A telephonic exit interview was conducted with Gregory Becker, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/15/2020 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20200915151817

FACILITY NAME:TERRAZA OF CHEVIOT HILLSFACILITY NUMBER:
197609050
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:3340 SHELBY DRTELEPHONE:
(310) 837-9181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:100CENSUS: 65DATE:
10/18/2020
UNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Gregory BeckerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility hallways are malodorous
INVESTIGATION FINDINGS:
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Regarding the allegation “Facility hallways are malodorous” On 09/15/2020 the department received an allegation that the hallway of the facility smells of urine and feces all the time. On 09/21/2020 LPA interviewed 10 out of 65 residents. On 09/21/2020 R5 stated that “It smells bad, not so much in the hallway but when I pass by R11's room it smells like somebody just went number 2.” R8 stated that “During weekends it smells like feces on the 2nd floor.” R9 stated “It does smell like feces, it’s coming from upstairs.” On 09/21/2020 LPA interviewed 7 out of 43 staff. Staff S1 stated that “It smells when the residents use the restrooms and it permeates through the hallways, but staff usually gets to it immediately.”. Staff S6 stated “The smell is more during the mornings.”. Staff S7 stated “R11 has been having continence issues and has had urine and feces on their apartment floor." Based on interviews, the preponderance of evidence standard has been met therefore the above allegation is found to be substantiated. California Code of Regulations, Tittle 22 are being cited please see LIC 9099D.
An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Administrator Gregory Becker.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20200915151817
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: TERRAZA OF CHEVIOT HILLS
FACILITY NUMBER: 197609050
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2020
Section Cited
CCR
87625(b)(3)
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87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
This requirement was not met as evidenced by:
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Administrator agreed to conduct a re-assessment of R11's condition, adminstrator will ask carpert cleaning service to clean R11's room and will have staff document when they clean incotninent residents rooms and submitt proof of correction by POC due date.
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Based on interviews the licensee failed to ensure the facility remains free of odors from R11's incontinence which poses a potential health and safety risk to residents in care.
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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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4