197609336-5-26-2023-11-AS-MVAO-CT7PPP-20230627112948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609336
Report Date: 05/26/2023
Date Signed: 05/26/2023 09:27:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
09/28/2022 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220928135021

FACILITY NAME:	WELBROOK SENIOR LIVING SANTA MONICA		FACILITY NUMBER:	197609336
ADMINISTRATOR:	KRISTIN BECK		FACILITY TYPE:	740
ADDRESS:	1450 17TH STREET		TELEPHONE:	(424) 282-3002
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	50	CENSUS: 41	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Dana Anderson-Executive Director		TIME COMPLETED:	09:26 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff double diaper residents in care.
Staff do not meet training requirements.

INVESTIGATION FINDINGS:

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

On 5/26/2023 Licensing Program Analyst (LPA) Alfonso Iniguez conducted a subsequent complaint investigation for the above listed allegations. LPA met with Dana Anderson/Executive Director of the facility and the purpose of the visit was explained to deliver findings for the above allegations.

On 10/5/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced initial complaint investigation for the allegations listed above. The investigation consisted of the following: Obtained copies of staff and client roster, Face sheet, Physician's Report, Appraisal, facility in service Training for staff and Reliance Training report. Interviews were conducted with staff #1-#5 and residents #1-#3. A tour of the facility was conducted with Chhadita Panday-Wellness Director.

Investigation revealed the following.

CONTINUE ON LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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 2

Control Number 11-AS-20220928135021

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WELBROOK SENIOR LIVING SANTA MONICA	FACILITY NUMBER: 197609336
	VISIT DATE: 05/26/2023

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

Allegation #1: Staff Double Diaper Resident in Care. It was alleged that staff trained new caregivers to double diapers residents. On 10/5/22 LPA conducted interviews with residents (R1-R3), all stated staff are not double diapering them and do not have any concerns with staff changing them. LPA conducted interviews with Welness Director -Chhandita Panday and staff members (S2-S5), staff stated they do not double diaper residents while in care. Staff also mentioned they have not trained other staff to double diaper residents. During interviews conducted, 2 out of 5 staff members stated they will use Incontinent shields guards for some of the residents that use the restroom frequently. Chhandita and staff S2-S5 stated residents are changed every 2-3 hours daily. LPA observed facility supply room to have several depends in stock. LPA also observed the incontinent guards that are used on residents. LPA reviewed caregivers in service and Relias Incontinent training. Based interviews conducted and observations, the department did not find sufficient evidence to support allegation the above allegation.

Allegation #2: Staff do not meet training requirements. It was alleged that several employees were not trained properly. On 10/5/23, LPA conducted an interview with Wellness Director-Chhandita, she stated new hires are trained and tracked using an online system software called Relias. She also stated staff are trained by experienced caregivers. LPA conducted interviews with staff members S2-S5. Staff stated they have completed training via online using Relias. Staff also mentioned that they trained new caregivers. LPA reviewed staff in service training on residents with dementia and Relias training history. Facility is in incompliance with dementia care training and the numbers of hours required. Based interviews conducted and observations, the department did not find sufficient evidence to support allegation the above allegation.

Unsubstantiated: “Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. California Code of Regulations.

During this visit LPA Iniguez did not observe deficiencies therefore no citations were issued at this time.
An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Administrator Dana Anderson.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2