198320127-1-17-2024-11-AS-MVAO-CZSW2U-20240124155455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 01/17/2024
Date Signed: 01/17/2024 04:15:47 PM

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
01/10/2024 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240110121519

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: 101	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Administrator Lilit Mnatsakanyan		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is not following Emergency Disaster Plan protocols.

INVESTIGATION FINDINGS:

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On 01/17/2024 9:20 AM, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to investigate the following allegations. LPM and LPA met with Business Office Manager Mariam Gezalian and explained the purpose of the visit. Administrator Lilit Mnatsakanyan joined the inspection later.

The investigation consisted of the following: During today’s investigation LPM, LPA, and staff conducted a tour of the facility which included the 14th floor, 3rd floor (Memory Care), 2nd Floor, and stairwells. LPM and LPA interviewed the Administrator and seven (7) staff members and interviewed 10 out of 101 residents. LPM and LPA reviewed the register of residents, Fire Safety Inc’s Fire Drill Reports conducted on 09/23/23, 10/30/23, 12/08/23, and 12/19/23, Personnel Report (LIC 500), and emergency disaster plan.

Continue to LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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-20240110121519

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: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 01/17/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation "Facility is not following Emergency Disaster Plan protocols," it is being alleged that the facility does not have a register of residents that indicates each resident’s location and ambulatory status readily available to first responders and that staff do not know what to do during emergency disaster drills. Record reviews indicate that the facility maintains an updated register of residents that indicates residents’ location and ambulatory status. During today’s visit, LPA requested the register of residents from the facility’s Administrator and Concierge, and it was provided on both occasions. Interviews with the Administrator and Director of Resident Care indicated that the register of residents will be provided to first responders. Record reviews indicate that fire safety and disaster trainings provided by outside vendor included instructions on how to evacuate residents during emergencies. LPA conducted record review of emergency disaster plan and observed that the facility has an evacuation procedure plan in place. Staff interviews indicated the following: Seven out of seven staff were able to explain their roles during emergencies. Resident interviews indicated the following: Six out of ten residents indicated that, although they feel that the drills were chaotic when conducted, they feel that they would receive help in an emergency. Four out of ten residents were not available.

Regarding the allegation " Facility is not following Emergency Disaster Plan protocols," the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator Lilit Mnatsakanyan.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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