197609336-12-1-2023-11-AS-MVAO-CY82BJ-20231204161515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609336
Report Date: 09/07/2023
Date Signed: 12/01/2023 02:19:10 PM

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
08/31/2023 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20230831144630

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: 42	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Dana Anderson-Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not allow resident to make and receive confidential phone calls.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected on report created on 9/7/2023.

On 9/7/2023 LPA Alfonso Iniguez conducted and unannounced complaint visit. LPA Iniguez meet with Dana Anderson/Administrator. LPA explained the purpose of this visit.
Investigation Consisted of: LPA conducted interviews with Administrator (A#1), Staff (S#1-S#4) and residents (R#1-R#4). Also, LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, R#1-R#4 Identification and Emergency Information, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#4) Needs and Services Plan, (R#1-R#4) Medication Administration Record (MAR) and (R#1-R#4) Admissions Agreement and physical tour of the facility and a copy of staff training in Relias regarding Essentials of Resident Rights.

Evaluation Report continues LIC 9099-C

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: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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-20230831144630

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: 09/07/2023

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff do not allow resident to make and receive confidential phone calls.

The details of the complaint alleged that the facility staff snatched the telephone away from one of the residents.

During the records review, LPA Iniguez reviewed the following: R#1’s Admission Agreement. In section J (Visits and Communication) it is written that the facility encourages family and visitors to visit and communicate during the hours of 9:00 AM and 5:00 PM; however, A#1 stated that the phone is always available for residents to use 24/7, in case the residents don’t know how to use it a staff will help them. In addition, LPA reviewed the Statement of Residents’ Rights incorporated on the Admission Agreement a copy of Title 22 California Code of Regulations Section 87468 is add it. The number 14 speaks about residents having reasonable access to telephones to make and receive confidential calls. LPA reviewed R#1’s LIC 602A (Physician’s Report for Residential Care Facilities for the Elderly (RCFE)). The report states that R#1 is not confused or disoriented and has a mild cognitive impairment.

During the Interview with the Administrator (A#1), she stated that she knows the resident’s rights and that the staff just took a training on Relias regarding this topic. In addition, A#1 said that all residents can use the telephone in the facility at any time of the day. A staff member can assist if a resident needs help using the phone. Also, A#1 stated that all residents are allowed to have private conversations while using the telephone, and she is not aware of a staff intervening in a resident’s telephone conversation, not giving privacy to have the phone conversation, or staff taking away the phone from a resident.

During interviews with residents (R#1-R#4), 4 out of 4 stated that they know their rights as residents of an RCFE and they can access the telephone when needed. In addition, 4 out of 4 said that when using the phone, their calls are private, and no staff has ever intervened in their conversations or snatched the phone away.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230831144630

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: 09/07/2023

NARRATIVE

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During interviews with residents (R#1-R#4), 4 out of 4 stated that they know their rights as residents of an RCFE and that they can access the telephone when needed. In addition, 4 out of 4 said that when using the phone, their calls are private, and no staff has ever intervened in their conversations or snatched the phone away.

On 12/1/23 LPA returned to facility and reviewed R#1"s file and LIC 812 was created to document LPA's findings. In addition LPA interviewed R#1's and asked the following: R#1 stated that she has not spoken with RP recently, but R#1 said that if RP calls, they will receive their call. In addition, R#1 stated that they have not had any problems with RP before.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED.

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.

California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Dana Anderson/Administrator.

This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected on report created on 9/7/2023.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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