197609050-12-20-2021-11-AS-MVAO-CBWRGC-20220223120031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:01:21 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
12/13/2021 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211213092955

FACILITY NAME:	TERRAZA OF CHEVIOT HILLS		FACILITY NUMBER:	197609050
ADMINISTRATOR:	JOEY ALVARADO		FACILITY TYPE:	740
ADDRESS:	3340 SHELBY DR		TELEPHONE:	(310) 837-9181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	100	CENSUS: 49	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Doina "Stefanie" Radu, Acting Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not ensuring the residents are properly fed while in care

INVESTIGATION FINDINGS:

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On 12/20/2021, Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the following allegation. LPA Agard was met with Administrator, Doina "Stefanie" Radu and explained the purpose of the visit was to gather information regarding this complaint.

LPA requested copies of the following documents: Resident roster, Staff Roster, Medication Administration Records, Resident’s Appraisal, Needs and Service Plan and Physicians Report.

The investigation consisted of the following: LPA Agard toured the facility, conducted interviews with staff, residents, and reviewed records.

On 12/20/2021 LPA Agard delivered findings.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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-20211213092955

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: 12/20/2021

NARRATIVE

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Regarding the allegation: Staff are not ensuring the residents are properly fed while in care. It’s being alleged that a dietary requirement has come to an immediate halt after 14 years. The investigation revealed the following: 5 of 6 interviewed could not confirm the allegation to be true. R2-6 all state they either have no issues with receiving enough food or they have access to additional items, such as fruits, vegetables and juices. R2 and R3 state they receive “more than enough and sometimes too much,” respectively. R4 states, “everything is fine and there are no complaints with the food.” R5 states, “oh yes, plenty, I gained weight since I moved here.” R6 states, “sometimes the portions are small, but you can get another which I’ve done a few times.” R6 states they have access to additional portions of food, juices and fruits. “Oh yea, anytime you want.” R1 states, “the facility’s new manager is denying them access to prune juice and that they don’t eat the meals at the facility because they are so darn awful.”

During interviews with the staff. 5 out of 5 denied the allegation and confirmed that residents have access to additional items per their request. S1 states residents are not denied food ever. S2 states there is one resident that would take a shopping bag to the kitchen and request items in bulk. The facility discouraged this because the resident has access to items daily at the bistro or at their request. S3 & S4 states that R1 would come to the facility kitchen and request a “list of items. S4 states, “R1 request a bunch of food items at once, like 15 bananas and they don’t use them, so they go bad in the room and when housekeeping comes to clean, they find all this rotten food.” S5 states she is following the directives of S1 and that R1 used to request a list of items. “Before, we gave like 15 prune juices at once, 15 bottle waters. Now I have a new boss that said we cannot give that many at once anymore. The residents can request each day.”

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. 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.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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