198320127-8-27-2025-11-AS-EMAZ-DMRVMV-20251024163409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 08/27/2025
Date Signed: 08/27/2025 07:04:38 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, 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
08/20/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250820132156

FACILITY NAME:	CALLIGRAPHY WESTWOOD VILLAGE		FACILITY NUMBER:	198320127
ADMINISTRATOR:	STEPHANIE KOFFMAN		FACILITY TYPE:	740
ADDRESS:	947 TIVERTON AVENUE		TELEPHONE:	(310) 208-4590
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	237	CENSUS: 135	DATE:	08/27/2025
		UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Tommy Farid Taheri/ Assistant Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not take proper steps to mitigate the spread of a communicable disease.

INVESTIGATION FINDINGS:

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On 8/27/2025 at approximately 11:45 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met Tommy Farid Taheri/Assistant Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director’s Interview (A#1), Residents Interviews (R#1-R#9) and Staff Interview (S#1-S#10). LPA obtained and reviewed the following documents: Resident Roster dated: 8/27/25, Staff Roster dated: 8/27/25, copy of facility’s Infection Control Plan dated: 7/15/25, Copies of Unusual Incident Report or LIC 624 dated: 8/15/25, 8/17/25, 8/19/25, 8/20/25 and 8/21/25, copy of email sent to the County Department of Public Health dated: 8/20/25.

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: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

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-20250820132156

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: CALLIGRAPHY WESTWOOD VILLAGE	FACILITY NUMBER: 198320127
	VISIT DATE: 08/27/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff did not take proper steps to mitigate the spread of a communicable disease.

The details of the complaint alleged that facility management are telling facility staff to come to work while they are sick.

On August 27, 2025, at approximately 1:00 P.M., during the records review, LPA Iniguez observed the facility’s Infection Control Plan dated 7/15/25. LPA observed that the plan follows the following guidelines: Infection Control Lead, Infection Control Training, Standard Precautions, Hand Hygiene, Personal Protective Equipment, Cleaning and Disinfection, Respiratory Etiquette, Injections, Sharps, when a Resident has a Communicable Disease, and Emergency Infection Control Plan. Additionally, LPA Iniguez observed the copies of the Unusual Incident Reports or LIC 624 dated August 15, 25 17, 19, and 20, 25, and the Incident Reports were sent to CCLD via fax, along with a copy of the email sent to the County Department of Public Health dated August 20, 25.

On August 27, 2025, at around 3:00 PM, during a health and safety check of the facility, LPA Iniguez observed hand sanitizing stations in the common areas and noticed signs in the elevators asking individuals to wear masks.

On August 27, 2025, at approximately 12:00 PM, during an Interview with the Assistant Executive Director (A#1), he stated that the steps the facility take to mitigate the spread of Covid-19, or other infectious disease are the following: we immediately put up a letter to inform the residents regarding the active cases in the facility, we sanitized high traffic areas, we asked the residents if they present symptoms to self-isolate and of course if they agreed to do it. We also informed the Department of Public Health and CCLD regarding the active cases.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250820132156

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: CALLIGRAPHY WESTWOOD VILLAGE	FACILITY NUMBER: 198320127
	VISIT DATE: 08/27/2025

NARRATIVE

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Additionally, (A#1) stated that facility staff do not come to work if they are diagnosed with COVID-19 or other infectious diseases, and he has never told a facility staff member to come to work when they are sick; on the contrary, he tells them to stay home.

On August 27, 2025, at approximately 1:00 PM, during an interview with residents (R#1-R#9), (8) out of (9) stated that the facility has a protocol in place regarding COVID-19 or other infectious diseases. In addition, (9) out of (9) residents in care stated that they have not seen any facility staff coming to work sick.

On August 27, 2025, at approximately 1:00 PM, during an interview with facility staff (S#1-S#10), (10) out of (10) stated that the facility has a protocol in place regarding COVID-19 or other infectious diseases. In addition, (10) out of (10) facility staff stated that they have not been asked by management to come to work while they are sick.

During this investigation, LPA did not find sufficient evident 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 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.

An exit interview was conducted, and a copy of the Complaint Report was given to Tommy Farid Taheri/Assistant Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

LIC9099 (FAS) - (06/04)

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