197609050-11-13-2020-11-AS-MVAO-BZ6RF7-20210316125840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 11/12/2020
Date Signed: 11/13/2020 09:46:56 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

COMPLAINT CONTROL NUMBER: 11-AS-20201012093642

FACILITY NAME:	TERRAZA OF CHEVIOT HILLS		FACILITY NUMBER:	197609050
ADMINISTRATOR:	GREG BECKER		FACILITY TYPE:	740
ADDRESS:	3340 SHELBY DR		TELEPHONE:	(310) 837-9181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	100	CENSUS: 66	DATE:	11/12/2020
		ANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	ADMINISTRATOR GREG BECKER		TIME COMPLETED:	01:44 PM

ALLEGATION(S):

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Residents rooms are not being cleaned due to lack of staff
Staff did not ensure facility is free from insects

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, Employee staff records for covid-19 training, Admission agreement, house cleaning documentation and pest control reports. On 10/20/2020 LPA Calderon interviewed S2-S3 and on 10/30/2020 interviewed S4-S5. On 10/15/2020 LPA Calderon interviewed Residents R1– R7 and on 10/30/2020 interviewed R8-R10.

The investigation revealed the following:
Allegation: Residents rooms are not being cleaned due to lack of staff.
It is alleged on 10/12/2020 facility staff failed to clean residents’ room due to staffing being cut in half the facility kitchen was not being cleaned and there were issues with resident’s food. On 10/19/2020 LPA Calderon interviewed Administrator Greg Becker, he stated some residents were under covid-19 protocols and in a “Red Zone”, but the facility was cleaned daily, and pest control sprayed monthly for insects. On 10/20/2020 and 10/30/2020 LPA Calderon interviewed Staff S2-S5 who stated that the facility to include rooms and the kitchen is cleaned daily, there are no staffing issues and no insects. On 10/15/2020 and 10/30/2020 LPA Calderon interviewed Residents R1 – R10, all residents stated that their rooms are cleaned daily and there no insect issues. All residents state that all their needs including medical are taken care of and there are no issues. On 10/19/2020 LPA Calderon toured the facility and all resident rooms toured and common areas appeared clean at the time of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020

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-20201012093642

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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Allegation: Staff did not ensure facility is free from insects.
It is alleged that staff did not ensure the facility is free from insects.
LPA received pest control records from facility indicating that pest control is done on a monthly basis and there were no insect issues. On 10/19/2020 LPA Calderon interviewed Administrator Greg Becker, some residents were under covid-19 protocols and in a “Red Zone”, but the facility was cleaned daily, and pest control sprayed monthly for insects. On 10/20/2020 and 10/30/2020 LPA Calderon interviewed Staff S2-S5 who stated that the facility to include rooms and the kitchen is cleaned daily, there are no issues with insects. On 10/15/2020 and 10/30/2020 LPA Calderon interviewed Residents R1 – R10, all residents stated that their rooms are cleaned weekly and there are no insect issues. On 10/19/2020 LPA Calderon toured the facility and did not observe insects.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A telephonic exit interview was conducted with Greg Becker, Administrator and a copy of this report was email for signature. Appeal rights explained and a copy was emailed.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2020

LIC9099 (FAS) - (06/04)

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