197609336-4-7-2022-11-AS-MVAO-CDUPQJ-20220426113113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609336
Report Date: 04/07/2022
Date Signed: 04/07/2022 04:01:11 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20211116082225

FACILITY NAME:	WELBROOK SENIOR LIVING SANTA MONICA		FACILITY NUMBER:	197609336
ADMINISTRATOR:	COLE, DAVID		FACILITY TYPE:	740
ADDRESS:	1450 17TH STREET		TELEPHONE:	(424) 282-3002
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	50	CENSUS: 34	DATE:	04/07/2022
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Chhandita Panday		TIME COMPLETED:	04:06 PM

ALLEGATION(S):

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Staff mismanaged resident's medications.
Resident's hygiene needs are not being met.
Staff are not allowing residents to have visitations.

INVESTIGATION FINDINGS:

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On 4/7/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA called facility and spoke with Wellness Director Chhandita Panday, to conduct covid-19 risk assessment. Facility is currently clear of covid-19 infections. LPA arrived at facility and was greeted by staff. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted entry.

The investigation consisted of the following:

On 4/6/2022 LPA Cifuentes interviewed Administrator David Cole and Wellness Director Chhandita Panday. LPA toured the facility grounds, reviewed facility files and requested and received copies of documents pertinent to the investigation. On 4/7/2022 LPA Cifuentes interviewed Staff (S1-S5), residents (R1-R5) and witnesses (W1-W3).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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-20211116082225

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
MONTERY PARK, CA 91754

FACILITY NAME: WELBROOK SENIOR LIVING SANTA MONICA	FACILITY NUMBER: 197609336
	VISIT DATE: 04/07/2022

NARRATIVE

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Allegation: Staff mismanaged resident's medications

It is alleged that staff have mismanaged residents’ medications. LPA reviewed medication administration records and found no issues in the files reviewed. LPA spoke with administrator, who states there have been no issues with medication for residents. LPA spoke with residents (R1-R5) regarding the allegation. Of those interviewed, all five stated there have been no issues with their medications. LPA spoke with staff (S1-S5) and of the staff questioned, five out of five stated there have been no issues with residents’ medications. LPA also interviewed witnesses (W1-W3) and all three stated there were no issues with residents’ medications. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Resident's hygiene needs are not being met.

It is alleged that residents are not being bathed or groomed. LPA reviewed weekly shower schedule for residents, which show that most residents get one to three showers a week. LPA spoke with residents (R1-R5) regarding the allegation. Of those interviewed, all five stated they do not require assistance with their ADL’s. LPA spoke with staff (S1-S5) regarding allegations. Of the staff questioned, five out of five stated a good majority or the facility residents receive assistance with their bathing and grooming, and five out of five also stated that all residents are bathed and groomed according to their care plan needs. LPA interviewed witnesses (W1-W3) regarding the allegations and two out of three stated residents received assistance with bathing and grooming, with the last being independent. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff are not allowing residents to have visitations.

It is alleged that facility is not allowing residents to have visitors. LPA spoke with administrator David Cole, who states because facility is a memory care and due to the physical size of building, visitation is on patio outside or in residents’ room. It is one to one and visitor must wear a mask, if not vaccinated must visit outside. LPA spoke with residents (R1-R5) regarding the allegation. Of those interviewed, all five stated they are allowed visitors and there have been no issues with visitation. LPA spoke with staff (S1-S5) regarding allegations. Of the staff questioned, five out of five stated residents are allowed visitation. LPA interviewed witnesses (W1-W3) regarding the allegations and three out of three stated residents are allowed visitation. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegations: “Residents threaten another resident in care,” “Facility staff refusing to give medications to resident, ”Staff mismanaged resident's medications”, ‘Resident's hygiene needs are not being met”, “Staff are not allowing residents to have visitations.”

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted, a copy of this report left with Rommelyn Miranda.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC9099 (FAS) - (06/04)

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