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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 11/12/2020
Date Signed: 02/26/2021 09:16:34 AM



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
10/12/2020 and conducted by Evaluator Jose Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201012140740
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: 66DATE:
11/12/2020
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:ADMINISTRATOR GREG BECKERTIME COMPLETED:
09:02 AM
ALLEGATION(S):
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9
Staff did not provide appropriate assistance for dehydration needs of resident.
INVESTIGATION FINDINGS:
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On 10/30/2020 around 1:00pm Licensing Program Analyst (LPA) Jose Calderon initiated an investigation for the allegation complaints 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 via face time with Administrator Greg Becker.

The Investigation consisted of the following: On 10/19/2020 LPA Calderon interviewed Administrator Greg Becker and conducted a tour of the physical plant. LPA obtained and reviewed copies of staff and Resident Roster, Admission agreement for R1, house cleaning documentation. On 10/19/2020, 10/20/2020 LPA Calderon interviewed S2-S3. On 10/15/2020 and 10/30/2020 LPA Calderon interviewed Residents R2–R11. LPA attempted to interview R1 but was unsuccessful due to communication barriers.

Allegation: Staff did not provide appropriate assistance for dehydration needs of resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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 2
Control Number 11-AS-20201012140740
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: 11/12/2020
NARRATIVE
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It is alleged that staff did not give R1 any liquids to drink. On 10/19/2020 LPA Calderon interviewed Administrator Greg Becker, stated that the facility had given R1 water and Gator-Aid to drink per the POA request.On 10/20/2020 LPA Calderon interviewed Staff S2-S3 who stated that they did give R1 Gator-Aid and there was no issues. On 10/15/2020 and 10/30/2020 LPA Calderon interviewed Residents R2 – R11, all residents stated that their there were no issues getting drinks from the facility or staff.

Although the allegation may have happened or is valid, there is a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2