197609050-10-19-2021-11-AS-AJKK-C89VHH-20211029162712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 10/19/2021
Date Signed: 10/19/2021 05:39:38 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
10/18/2021 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211018114753

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: 54	DATE:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Adminstrator, Joey Alvarado		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident did not receive medication as prescribed.

INVESTIGATION FINDINGS:

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On 10/19/2021 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, Joey Alvarado and explained the purpose of the visit was to gather information regarding this complaint.

The investigation consisted of the following: LPA Agard toured the facility, conducted interviews with staff, residents, a resident’s responsible party and reviewed records.

On 10/19/2021 LPA Agard delivered findings.

Regarding the allegation: Resident did not receive medication as prescribed. It’s being alleged that a resident who was prescribed a certain brand of eye drops had their order discontinued for a cheaper brand that causes their eyes to burn. The investigation revealed the following: S1 states, R1 returned from
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: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

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-20211018114753

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: 10/19/2021

NARRATIVE

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rehabilitation with a change in medication. S1 was not aware of the discomfort the medication was causing resident but states the facility did not make any changes. W1 states, the changes in medication was done by W2. “W2 made the changes to the medication due to the cost. They stated the medication was too expensive and that they weren’t going to pay for it.” W2 confirmed that they made the changes to the medication back in September 2021 due to the cost. “I’m only trying to look out for R1. It is not the facility’s fault. They do a great job.” S2 states, overhearing R1 complaining about the medication burning their eyes. S2 states the medication was what was prescribed when resident returned from rehabilitation. S3 states not being aware of the complaints from R1 and that the medication, which was causing discomfort, was recently discontinued and will return back to the original prescribed med prior to leaving the facility.

During interviews with the residents the following was revealed. R1 states they are aware that W2 made the changes and it is “not their business to make changes.” R1 states it was not supposed to be changed and it was done because of the cost. R1 states “W2 changed it out of cheapness.” R2-4 state generally not having issues with medication at the facility. R5 was unable to answer the questions due to their cognitive ability.

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(s) 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: 10/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

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