197609336-6-14-2022-11-AS-MVAO-CFMNG2-20220622102625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609336
Report Date: 06/07/2022
Date Signed: 06/14/2022 11:54:54 AM

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
02/02/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220202090557

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: 35	DATE:	06/07/2022
		UNANNOUNCED	TIME BEGAN:	11:11 AM
MET WITH:	Kristin Beck		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not follow resident's hospice care plan
Staff performed medical procedure on resident
Staff do not provide proper medication management to residents in care
Resident's call button is not answered in a timely manner
Staff did not inform physician of resident's change in condition
Facility does not have an evacuation chair at each stairwell
Facility delayed egress doors are in disrepair
Staff does not have required training
Facility did not report resident incidents to appropriate parties

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 6/7/2022.

On 6/7/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. 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 2/9/2022 LPA Cifuentes interviewed Wellness Director Chhandita Panday. LPA toured the facility grounds, reviewed facility files and requested and received copies of documents pertinent to the investigation. On 5/10/2022 LPA Cifuentes interviewed Staff (S1-S5), residents (R1-R5) and requested further documentation.

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: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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 5

Control Number 11-AS-20220202090557

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: 06/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 6/7/2022.

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not follow resident's hospice care plan

It is alleged that staff do not follow resident’s hospice care plans. LPA reviewed hospice care plans for three residents. LPA spoke with facility nurse, who stated that some facility residents have hospice services and have associated care plans which are reviewed by facility staff when received and added to resident’s facility care plan, with any changes being made as indicated by hospice. LPA spoke with residents (R1-R5) regarding the allegation, of those questioned, four were unable to answer due to their medical condition and one stated they were not on hospice. Per facility files, three of them are receiving hospice services. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, five out of six stated facility staff follow resident’s hospice care plan. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff performed medical procedure on resident

It is alleged that staff performed a medical procedure on a resident. LPA spoke with Nurse Chanditha Panday who stated staff do not perform medical procedures on resident, only visiting nurses perform tasks that are considered medical procedures. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, five out of six stated they have not performed medical procedure on residents, nor have they seen other staff perform medical procedure on residents. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff do not provide proper medication management to residents in care

It is alleged that facility staff is making medication errors. LPA reviewed medication administration records and found no errors. LPA Cifuentes spoke with administrator David Cole regarding medication management for residents. Per administrator Cole, Facility Nurse and Medtech handle medications for residents and make sure the right medications are being given timely. He reported no complaints or issues have been reported. LPA spoke with residents (R1-R5) regarding the allegation. Of those interviewed, four were unable to answer due to their medical condition and one stated they were getting medications, they just did not know which kind. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, five out of six stated residents are receiving proper medication management. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20220202090557

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: 06/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 6/7/2022.

Allegation: Resident's call button is not answered in a timely manner

It is alleged that residents call buttons are not answered timely and that management does not check the call logs to verify that residents have been answered. LPA took a tour of facility grounds. Facility only has pull cords to call staff in communal bathrooms. Residents bedrooms are equipped with a motion triggered digital alert system with specific setting for each resident depending on their needs. Per Nurse Chanditha Panday, if any of the alerts from the system are not answered by staff, the facility nurse and administrator are notified. Nurse Panday added that all the staff run when the alerts go off. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, five out of six stated facility does not have the usual call button system, and that when they are alerted by the sensors, they answer as quickly as possible. Based on information gathered, the department did not find sufficient evidence to support the allegation.

Allegation: Staff did not inform physician of resident's change in condition

It is alleged that facility staff is not reporting falls or changes of condition to residents physician. LPA reviewed facility files and found copies of faxes sent to resident’s primary care physicians regarding changes in condition, medications or other needs. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, four out of six stated falls and changed in condition are reported to residents doctors. Based on information gathered, the department did not find sufficient evidence to support the allegation.

Allegation: Facility does not have an evacuation chair at each stairwell

It is alleged that facility does not have evacuation chairs in each stairwell. LPA took a tour of facility grounds. Facility has two staircases leading from ends of second floor hallways to exterior of facility. Each stairwell has an evacuation chair secured to the wall at the top of each staircase. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, six out of six stated a facility has evacuation chairs in both stairwells. Based on information gathered, the department did not find sufficient evidence to support the allegation.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20220202090557

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: 06/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 6/7/2022.

Allegation: Facility delayed egress doors are in disrepair

It is alleged that facilities delayed egress doors are in disrepair and residents can get out just by pushing on doors. LPA took a tour of the facility grounds. Facility has 8 delayed egress doors, four of which are double doors at the front and back of the facilities first floor. LPA Cifuentes tested all eight doors and found that the delayed egress doors are in good repair. Administrator David Cole stated he checks the doors frequently to make sure they are in working order, which was seconded by one of the staff. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, six out of six stated facility delayed egress doors are in good repair. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation

Allegation: Staff does not have required training

It is alleged that staff are not properly trained and learn as they go on the job. LPA reviewed facility files and found several staff training's which have taken place over the last few years. Per Administrator David Cole, facility conducts in person and online training's yearly as required by title 22 in addition to the required training's at the beginning of employment with an additional 20 hours of on the job training. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, five out of six stated they completed in person and online training. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20220202090557

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: 06/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 6/7/2022.

Allegation: Facility did not report resident incidents to appropriate parties

It is alleged that facility staff is not reporting falls or changes of condition to doctors or licensing division. LPA Cifuentes reviewed facility files and found copies of faxes sent to resident’s primary care physicians, The faxes covered changes in condition, medications or other needs. LPA also noted that SIRS have been sent to Community Care Licensing.. LPA spoke with residents (R1-R5) regarding the allegation. Of those interviewed, four were unable to answer due to their medical condition and one stated they had not had any falls or changes in medical condition that needed to be reported to their family or others. LPA spoke with staff (S1-S6) regarding allegations. Of the staff questioned, four out of six stated falls and changes in condition are reported to doctors and family members, but not all were sure if it was reported to Community Care Licensing as they did not handle the reporting. 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: “Staff did not follow resident's hospice care plan,” “Staff performed medical procedure on resident,” “Staff do not provide proper medication management to residents in care,” “Resident's call button is not answered in a timely manner,” Staff did not inform physician of resident's change in condition,” “Facility does not have an evacuation chair at each stairwell,” “Facility delayed egress doors are in disrepair,” “Staff does not have required training,” “Facility did not report resident incidents to appropriate parties.”

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, and a copy of this report provided to Kristin Beck, Administrator.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5