198204999-8-14-2025-11-AS-SCIS-DM4TSW-20251003145950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204999
Report Date: 08/13/2025
Date Signed: 08/14/2025 06:49:27 AM

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
08/04/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20250804161918

FACILITY NAME:	AMERICARE ASSISTED LIVING OF WESTCHESTER		FACILITY NUMBER:	198204999
ADMINISTRATOR:	PATRICK BAUTISTA		FACILITY TYPE:	740
ADDRESS:	8501 RAMSGATE AVENUE		TELEPHONE:	(310) 641-5808
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	6	CENSUS: 6	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Leia Joaquin and Patrick Bautsta		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff not allowing resident phone usage.
Staff does not leave resident’s phone within reach.

INVESTIGATION FINDINGS:

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On August 13, 2025, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Licensee Leia Joaquin and staff Patrick Bautsta and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of the following: On August 13, 2025, the Department requested and reviewed Resident #1's records. The following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 03/29/2025 ), Resident Roster (dated 05/01/2025 ), Admission Agreement (dated 06/02/2023) Identification and Emergency Information (dated 03/30/2021 ), Physician’s Report (dated 01/30/2023 ), Medical Assessment (dated 07/11/2022 ), Medication Administration Records (MARs) (dated 08/01/2025-08/13/2025 ), Appraisal & Needs and Services Plan (dated 04/22/2025), Functional Capability Assessment (dated 03/30/2021 ), Preplacement Appraisal Information (dated 03/30/3021 ), Personal Rights (dated 03/30/2020), Telecommunications Device Notification (03/30/2021), Consent Forms (date 01/30/2023).
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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 3

Control Number 11-AS-20250804161918

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: AMERICARE ASSISTED LIVING OF WESTCHESTER	FACILITY NUMBER: 198204999
	VISIT DATE: 08/13/2025

NARRATIVE

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Continued LIC9099-C page 2
Interviews were conducted with Staff Members #1–4 (S1–S4) and Residents #1-4 (R1-R4). LPA attempted to interview Residents #5-6 (R6-R5); however, R5 is nonverbal, and R6 spoke only a few words and was unable to answer any of the questions. At 11:00 A.M., the department toured the facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit.

Investigation revealed the following:
Allegation: Staff not allowing resident phone usage.
It was alleged that staff were not allowing a resident to use the phone. On August 13, 2025, between 11:00 a.m. and 4:00 p.m., the Department interviewed Staff #1-4 (S1-S4). Four (4) out of the four (4) staff stated that residents are allowed to use the phone. Residents may use the facility phone to make and receive calls.
S1-S4 stated that resident #1 (R1) is deaf. S1 and S2 reported that a telecommunication device had been installed in R1's room to accommodate individuals who are deaf or hearing impaired. 4 out of 4 staff confirmed that R1’s phone was not busy for two days and that it was operable and in working condition.

S1–S4 stated that R1’s Caption Telephone Device is internet-connected and may lose signal if the internet is weak. The device has cords, a plug, and other components connected to an electrical outlet; S1-S4 stated that R1 may inadvertently disconnect it by pulling on the cords. S1-S4 reported that they routinely check the phone and its connection to ensure R1 has access. When the phone rings, staff verify that R1 answers, as R1 may not notice an incoming call if she is not looking at the device.

S1-S4 also stated that R1 only receives calls on that phone from a single individual, who calls numerous times throughout the morning, day, and night, often back-to-back. S1-S4 stated that sometimes R1 is sleeping. 4 out of 4 staff stated that R1's phone is not left off the hook and that staff are not preventing R1 from speaking to anyone. Four (4) out of (4) residents denied the allegation.

On August 13, 2025, between 11:00 a.m. and 4:00 p.m., the Department interviewed Resident #1-4 (R1-R4). Four (4) out of the (4) residents stated that they are allowed to use the phone. Residents may use the facility phone to make and receive calls. 2 out of 4 residents reported that they have cellphones. 1 out of 4 residents stated they use the facility landline, and 1 out of 4 residents stated that they use the Caption Telephone Device. Four (4) out of (4) residents denied the allegation. See continued LIC9099-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250804161918

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: AMERICARE ASSISTED LIVING OF WESTCHESTER	FACILITY NUMBER: 198204999
	VISIT DATE: 08/13/2025

NARRATIVE

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Continued LIC9099-C page 3

On August 13, 2025, at 4:24 p.m., the Department interviewed Witness #1 (W1). W1 stated that residents are allowed to use the phone and may use the facility phone to make and receive calls. W1 states that there has never been a problem with contacting the facility phone. W1 states that they never call R1’s hearing assistance phone, which is located next to the bed and chair. W1 explained that the Licensee went out of their way to obtain the telephone device for R1. W1 also stated that only one person calls that phone, and the device is functioning properly. W1 states that it is an internet-connected phone, so if the internet or power goes down, the device would be affected. W1 states that if anyone needs to contact the facility, they can call the landline. W1 states that staff are always available to assist and are doing a wonderful job. W1 denied the allegation. During today's visit, the Department observed R1's Caption Telephone Device, reviewed the phone log, received copies showing the dates and times of incoming calls from July 15, 2025, through August 13, 2025, and tested R1's phone and volume by placing a call to it. The phone rang very loudly and could be heard throughout the facility.

Allegation: Staff does not leave the resident’s phone within reach.
It was alleged that staff do not leave the resident’s phone within reach. On August 13, 2025, between 11:00 a.m. and 4:00 p.m., the Department interviewed Staff #1-4 (S1-S4) and Resident #1 (R1). Four (4) out of the four (4) staff members stated that R1's phone is located next to the bed and chair, within reach. 4 out of 4 staff denied the allegation. R1 confirmed during the interview that the phone is positioned next to the bed and chair and is within reach. At 4:24 p.m., on that same day, the Department interviewed Witness #1 (W1), who also stated the phone is located next to R1's bed and chair and is within reach.

On August 13, 2025, at 10:30 a.m., the Department observed the phone within reach, positioned on a table next to R1's bed and chair.

Based on interviews, available evidence, observation, information received, and records reviewed, there was not enough sufficient evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed unsubstantiated.
There were no deficiencies cited. LPA Bunker provided staff Patrick Bautsta with copies of the LIC9099 and LIC9099Cs Complaint Investigation Reports. An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

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