197609336-11-8-2023-11-AS-EMAZ-CYA2L2-20231206162848

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609336
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:15:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/02/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20231102134318

FACILITY NAME:	WELBROOK SENIOR LIVING SANTA MONICA		FACILITY NUMBER:	197609336
ADMINISTRATOR:	COLE, CATALINA		FACILITY TYPE:	740
ADDRESS:	1450 17TH STREET		TELEPHONE:	(424) 282-3002
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	50	CENSUS: 41	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	ADMINISTRATOR DAVID COLE		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff impose restrictions on resident’s visitors.
Staff do not allow resident to receive phone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Welbrook Senior Living Santa Monica facility on 11/08/2023 and was greeted by Administrator David Cole (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

Investigation consisted of: LPA Calderon interviewed Administrator David Cole A1, S1, R1-R4. These interviews were conducted on 11/08/2023. On 11/08/2023 LPA Calderon obtained and reviewed the following: Copy of the court conservatorship (dated 09/26/2023) Physician Report (dated 10/27/2022), Copy of visiting policy (dated ##/##/####). Emails (dated 12/22/2022, 8/2/2023 and 10/24/2023).

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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-20231102134318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WELBROOK SENIOR LIVING SANTA MONICA	FACILITY NUMBER: 197609336
	VISIT DATE: 11/08/2023

NARRATIVE

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Regarding Allegation #1: Staff impose restrictions on residents’ visitors.

This complaint alleged facility did not allow Reporting party access to R1. LPA Calderon conducted an interview with A1. A1 states that the reporting party has called R1 and made R1 agitated and mad. A1 states that the reporting party has never visited R1 at the facility and in general there are no restrictions for family or guests to visit R1. A1 states that A1 received an email from the conservator on 10/24/2023. The email from the conservator states to preclude reporting party from visiting R1. LPA Calderon conducted an interview with S1. S1 states that the staff has never prevented the reporting party from visiting R1 at the facility until the conservator precluded reporting party from visiting R1. LPA Calderon conducted an interview with R1. R1 states that R1 does not have any issues with reporting party visiting R1 at the facility but reporting party lives in Northern California. LPA Calderon conducted an interview with R2-R4. 3 out of 4 residents state that the facility has not stopped friends or family members visiting them. Reviewed email (dated 10/24/2023) from R1 conservator to A1 regarding reporting party visitations. The conservator has precluded reporting party from visiting R1. LPA Calderon conducted an interview with R1 conservator. The conservator states that facility staff has advised conservator that R1 has cried after speaking to reporting party and conservator has precluded reporting from visiting R1.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231102134318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WELBROOK SENIOR LIVING SANTA MONICA	FACILITY NUMBER: 197609336
	VISIT DATE: 11/08/2023

NARRATIVE

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Regarding Allegation #2 Staff do not allow residents to receive phone calls.

This complaint alleged facility did not allow calls from RP to R1. LPA Calderon conducted an interview with A1. A1 states that the reporting party has called R1 and made R1 agitated and mad. A1 states that the reporting party has called R1 many times with no issues. A1 states that reporting would tell R1 that the conservator would steal R1 money. A1 states that R1 would repeat what was told to R1 and R1 would start to cry and get mad. A1 states in general there are no restrictions for family or guests to call R1. A1 states that A1 received an email from the conservator on 10/24/2023. The email from the conservator states to preclude reporting party from calling R1. LPA Calderon conducted an interview with S1. S1 states that S1 witness R1 speak to the reporting party and that R1 would repeat that the conservator is stealing R1 money. S1 states that S1 reviewed the email dated 10/24/2023 precluded reporting party from calling R1. LPA Calderon conducted an interview with R1. R1 states that R1 does not have any issues with reporting party calling R1 at the facility. R1 states that the reporting party would never hurt her but R1 forgets past conversations. LPA Calderon conducted an interview with R2-R4. 3 out of 4 residents state that the facility has not stopped friends or family members from calling. Reviewed email (dated 10/24/2023) from R1 conservator to A1 regarding reporting party calls. The conservator has precluded reporting party from calling R1. LPA Calderon conducted an interview with R1 conservator. Conservator states that facility staff has advised conservator that R1 has cried after speaking to reporting party and conservator has precluded reporting from calling R1.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff impose restrictions on residents’ visitors” “staff do not allow resident to receive phone calls” is found to be UNSUBSTANTIATED.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator David Cole (A1).

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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