198320127-5-15-2025-11-AS-RORN-DHJTNJ-20250611145248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 05/15/2025
Date Signed: 05/15/2025 01:04:56 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2024 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240910162855

FACILITY NAME:	WATERMARK AT WESTWOOD VILLAGE, THE		FACILITY NUMBER:	198320127
ADMINISTRATOR:	LILIT MNATSAKANYAN		FACILITY TYPE:	740
ADDRESS:	947 TIVERTON AVENUE		TELEPHONE:	(310) 208-4590
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	237	CENSUS: 136	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Stephanie Koffman-Senior Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Licensee did not comply with facility theft and loss program requirements.
Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 5/15/24, at approximately 8:30 AM, Licensing Program Analyst-PA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Stephanie Koffman-Senior Executive Director and explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Senior Executive Director Interview (A#1), Residents 1 Interview (R#1) and Witness 1 interview (W#1). LPA obtained and reviewed the following documents: Resident Roster dated:5/6/25, Staff Roster dated:3/22/25, Copy of the Health and Safety Code 1569.153 regulation, copy of Los Angeles Police Department Victim’s Supplemental Property Loss Report filled by (R#1) and dated on:8/26/24, Copy Excel spreadsheet of facility Initial Employee Trainings dated:9/20/2024, copy of 2024 facility staff trainings, copy of (R#1)’s of 1st Admissions Agreement dated:6/30/23, copy of (R#1)’s 2nd Admissions Agreement dated: 7/24/24, copy of (R#1)’s Client/Resident Personal Property and Valuables or LIC 621 dated: 7/5/24 and 7/25/24, and copy of (R#1)’s Physicians Report for Residential Care Facilities for the Elderly(RCFE) or LIC 602A dated:7/9/23.

Evaluation Report continues LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Licensee did not comply with facility theft and loss program requirements.

The details of the complaint alleged that licensee did not comply with the theft and loss program requirements of the Health and Safety Code 1569.153.

On May 2, 2025, at approximately 8:30 AM, the Licensing Program Analyst (LPA), Iniguez, observed a copy of (R#1) 's Admissions Agreement dated:6/30/23; the admission package did not include the Client/Resident Personal Property and Valuables or LIC 621 on it. Also, LPA Iniguez reviewed (R#1) 's second Admissions Agreement dated: 7/24/24, there was a Client/Resident Personal Property and Valuables or LIC 621 with two different dates: 7/5/24-signed by (R#1), and 7/25/24-signed by facility staff. The form has (R#1) 's name and social security number written, but no personal items were listed. Moreover, LPA Iniguez observed (R#1)’s Physicians Report for residential Care Facilities for the Elderly (RCFE) or LIC 602A dated:7/9/23, LPA Iniguez noticed that it is marked that (R#1) is not confused and disoriented, can follow instructions, and can communicate their needs. In addition, LPA Iniguez reviewed the Excel spreadsheet for the facility's Initial Employee Training, dated September 20, 2024, during a records review, LPA Iniguez noted that the spreadsheet did not include any information regarding the theft and loss program for new employees, which should be addressed within the first 90 days of employment, based on the Health and Safety Code 1569.153(b) regulation. In addition, LPA Iniguez reported that five staff members were hired in 2024, as indicated in the Personnel Report or LIC 500 dated September 1, 2024. Additionally, during a review of the facility's Course Completion History for 2024, LPA Iniguez noted that none of the five employees received training on the orientation to the policies and procedures of the theft and loss program, as required by Health and Safety Code 1569.153(b) regulation.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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On 9/18/24, at approximately 12:00 PM, during an interview with (R#1), they stated that when they moved in, they felt that they were not aware of what they were signing and felt pressure to sign documents they did not understand. Also, (R#1) stated that the facility failed to provide a copy of their signed LIC 621 twice.
Allegation:Staff did not safeguard resident's personal belongings.

The details of the complaint alleged that facility staff did not safeguard (R#1)’s personal belongings.

On September 18, 2024, during an initial complaint investigation at approximately 9:00 AM, LPA Iniguez conducted a health and safety check of the facility and (R#1) 's room, accompanied by (R#1). LPA Iniguez asked (R#1) about the missing items from their room. (R#1) mentioned that they noticed some jewelry was missing on the evening of the incident. They also discovered that five designer bags were gone a few days later. (R#1) explained that the jewelry was kept in a locked drawer, while the designer bags were in another piece of furniture in their bedroom, next to their bed. LPA observed where (R#1) stored their handbags and noted that only the dust bags bearing the designer's name were left behind. Photos were taken as evidence. Additionally, (R#1) showed LPA where their jewelry was stored. LPA observed that the jewelry was kept in a small drawer next to the bathroom and noted that (R#1) had not locked that drawer.

During the records review, LPA Iniguez observed that on 8/26/24, (R#1) filled out the Los Angeles Police Department Victim's Supplemental Property Loss Report, detailing stolen jewelry and its value. (R#1) claims that an unknown individual entered the facility that day and was escorted out by facility staff after 30 minutes being inside. Additionally, LPA reviewed the facility's video footage from the day of the incident. The video shows the intruder conversing with (R#1) in the elevator, during which the intruder asked (R#1) for their room number, to which (R#1) responded. LPA also viewed photographs of (R#1) 's jewelry that a friend had taken, identified as Witness #3 (W#3). (R#1) had requested (W#3) to document the jewelry with photographs.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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On 9/18/24, at approximately 11:00 AM, during an interview with the executive director (A#1), she stated that the day that (R#1) reported the missing items, a police report was made. In addition, (A#1) stated that there are no cameras on the hallways, only in the lobby and elevator, there is no video footage of an intruder going inside (R#1) 's room, and the resident's door locks use regular keys. Moreover, (A#1) stated that she observed (R#1) came down to the bistro, they would always have a purse and some jewels on her.

On 9/18/24, at approximately 12:00 PM, during an interview with (R#1), they stated that they always locked their door every time they go out. (R#1) mentioned that on the evening of the event, they noticed some jewelry was missing, and a few days later, they discovered five designer bags were missing. (R#1) explained that the jewelry was in a drawer with a lock, and the designer bags were in their bedroom next to her bathroom in a drawer. (R#1) stated that there were no signs of forceful entry on the door. (R#1) noted that a passkey can only open the door; the facility staff has this passkey. Additionally, (R#1) stated that they are living independently and can do their ADLs without staff assistance. (R#1) also stated that they can make their own medical and financial decisions.

On 9/18/24, at approximately 1:00 PM, during an interview with facility staff (W#2), she stated she had been (R#1) 's housekeeper since they moved into the facility. (W#2) stated that she had seen (R#1) 's jewelry and handbags in (R#1) 's room.

On 9/18/24, at approximately 2:00 PM, during an interview with (W#3), they stated that they took the pictures of (R#1) 's jewelry as requested by (R#1); also, (W#3) stated that they have seen (R#1) 's handbags and jewels.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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During this investigation, LPA found sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Stephanie Koffman / Senior Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 9

Citations on this Visit Report are Under Appeal!

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type B 07/15/2025 Section Cited CCR 87218(a)(2)	1 2 3 4 5 6 7	87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153. This requirement was not met as evidence by:	1 2 3 4 5 6 7	The licensee will adhere to Title 22 regulations at all times. The licensee shall reimburse (R#1) for or replace stolen or lost (R#1)'s property at its current value listed on the police report. Before the due date, a plan of correction (POC) will be submitted to the department.
	8 9 10 11 12 13 14	Based on a review of records and interviews, the facility failed to create and give the LIC 621 form to (R#1) upon admission on 2023 and second time they move on 2024, also, the facility failed to train facility staff regarding the orientation to the policies and procedures for all employees within 90 days of employment. This poses a potential health and safety risk to all residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 9 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2024 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20240910162855

FACILITY NAME:	WATERMARK AT WESTWOOD VILLAGE, THE		FACILITY NUMBER:	198320127
ADMINISTRATOR:	LILIT MNATSAKANYAN		FACILITY TYPE:	740
ADDRESS:	947 TIVERTON AVENUE		TELEPHONE:	(310) 208-4590
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	237	CENSUS: 136	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Stephanie Koffman-Senior Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not ensure a safe environment was provided for residents.

INVESTIGATION FINDINGS:

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On 5/15/25, at approximately 8:30 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Stephanie Koffman-Senior Executive Director. and explained the purpose of this visit.

Investigation consisted of the following: LPA Iniguez gathered the following documents: Copy of Resident Roster dated: 5/6/25, Copy of Personnel Report dated:3/22/25. LPA Iniguez conducted the following interview: Executive Director interview (A#1), Staff Interviews (S#1-S#8) and facility residents (R#1-R#12), and a Health and Safety Check of the facility.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff did not ensure a safe environment was provided for residents.

The details of the complaint alleged that facility staff did not ensure a safe environment was provided for (R#1) and the other residents in care.

On May 15, 2025, at approximately 1:00 PM, during a Health and Safety check at the facility, LPA Iniguez observed that a security guard was rounding the facility grounds. LPA Iniguez also observed the video cameras placed in the common areas and the secured gate by the parking entrance. In addition, LPA Iniguez observed the electronic sign-in system to register all visitors and vendors to the facility.

On May 15, 2025, at approximately 9:30 AM, during an Interview with the Administrator (A#1), she stated that the facility offers a safe environment for all residents in care. In addition, (A#1) state that the facility has a security guard available 24/7 who patrols the building. Additionally, there is video monitoring, a gated garage equipped with video surveillance and a call box, as well as an electronic sign system.

On May 15, 2025, at approximately 11:00 AM, during interviews with residents (R#1-R#12), (11) out of (12) stated that they think the facility offers a safe environment for them and everyone else. In addition, (11) out of (12) residents stated that they feel safe living here.

On May 15, 2025, at approximately 10:00 AM, during interviews with facility staff (S#1-S#8), (8) out of (8) stated that they think the facility offers a safe environment for all residents in care.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

Page: 7 of 9

Control Number 11-AS-20240910162855

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 05/15/2025

NARRATIVE

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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.

An exit interview was conducted, and a copy of the Complaint Report was given to Stephanie Koffman / Senior Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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