197609050-12-9-2022-11-AS-UCOL-CPFSNS-20230227130201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 12/09/2022
Date Signed: 12/09/2022 03:50:37 PM

Unsubstantiated

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
12/01/2022 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221201161909

FACILITY NAME:	TERRAZA OF CHEVIOT HILLS		FACILITY NUMBER:	197609050
ADMINISTRATOR:	DOINA STEPHANIE RADU		FACILITY TYPE:	740
ADDRESS:	3340 SHELBY DR		TELEPHONE:	(310) 837-9181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	100	CENSUS: 39	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Business Office Manager, Cecilio Sapp		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff yelled at resident
Staff failed to treat resident with respect

INVESTIGATION FINDINGS:

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On 12/09/22 Licensing Program Analyst (LPA) Antonia Alvizar conducted an initial unannounced 10-day complaint visit at this facility. LPA called the facility to conduct a risk assessment. LPA spoke with Administrator Robin Culver via-phone who confirmed the facility has (3) three positive Covid-19 cases. LPA met with Business Office Manager, Cecilio Sapp and explained the purpose of today's visit.

The investigation consisted of the following: LPA toured the facility with Business Office Manager, Cecilio Sapp. Interviews were conducted with residents #1 - #6 (R1-R6), staff #1 - #3 (S1- S3) and Witness #1 (W1). LPA obtained and reviewed R1’s admission agreement and other service records. LPA also requested and obtained staff roster and resident roster.

Investigation report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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-20221201161909

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: 12/09/2022

NARRATIVE

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Continuation from LIC 9099

The investigation revealed the following: Regarding the allegation “Staff yelled at residents.” During interviews conducted, 0 out of 6 residents agreed with the allegation. 4 out of 6 residents disagreed with the allegation, resident R1 stated “I don’t remember to be honest to you.” 2 out of 6 residents refused to be interviewed. 0 out of 3 staff agreed with the allegation. 3 out of 3 staff interviewed disagreed with the allegation staff S1 stated “I am not aware of that we have ongoing training.” Witness (W1) stated, “No, I have never witnessed nor heard any staff yelling at residents”. “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding the allegation “Staff failed to treat resident with respect.” During interviews conducted, 2 out of 6 residents agreed with the allegation, resident R1 stated,” Yes, staff failed to treat me with respect” 2 out of 6 residents disagreed with the allegation, resident R5 stated “Staff don’t never fail to treat us with respect they are very nice.” 2 out of 6 residents refused to be interviewed. 0 out of 3 staff agreed with the allegation. 3 out of 3 staff interviewed disagreed with the allegation staff S3 stated “I have never seen or heard any staff fail to treat residents with respect.” Witness (W1) stated, “No, I have never witnessed any staff treating residents lacking respect”. “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

No deficiencies cited. An exit interview was conducted and a copy of this report was provided to Cecilio Sapp.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC9099 (FAS) - (06/04)

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