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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 11/21/2025
Date Signed: 11/21/2025 02:32:54 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
11/05/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20251105144029
FACILITY NAME:CALLIGRAPHY WESTWOOD VILLAGEFACILITY NUMBER:
198320127
ADMINISTRATOR:STEPHANIE KOFFMANFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:237CENSUS: 137DATE:
11/21/2025
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Sthephanie Walters/Senior Executive DirectorTIME COMPLETED:
02:32 PM
ALLEGATION(S):
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Staff are not providing adequate food service to residents.
Staff left resident unattended for an extended period of time.
INVESTIGATION FINDINGS:
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On 11/21/2025 at approximately 9:00 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Stephanie Walters/ Senior Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director Interview (A#1), Facility Staff Interviews (S#1-S#9) and Resident Interviews (R#1-R#9). LPA gathered the following documents: Client Roster dated: 11/4/25, Staff Roster dated:11/4/25, copies of menus various dates and a health and safety check at the facility kitchen

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: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
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 4
Control Number 11-AS-20251105144029
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: 11/21/2025
NARRATIVE
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 Investigation Revealed the Following:

Allegation: Staff are not providing adequate food service to residents.

The details of the complaint alleged that food service to residents was delayed due to late distribution of menus

On November 21, 2025, at approximately 12:00 PM, during a review of records, Licensing Program Analyst (LPA) Iniguez observed that the facility had copies of the menus available for the period from October 19 to November 8, 2025. These menus were distributed to all residents in care one week prior to their effective dates. Additionally, LPA Iniguez noted the presence of an alternate menu that is consistently available to residents at any time of day. This alternate menu is posted at the food bar in the facility's dining area.

On November 6, 2025, during an interview, the Executive Director (A#1) stated that the facility follows a consistent process to ensure residents are informed about upcoming meals. When a new menu is developed, it is printed and posted in the dining area for visibility, and it is also distributed directly to all residents at least one week before the start of the menu cycle. This practice allows residents sufficient time to review meal options and communicate any dietary requests or preferences. Additionally, (A#1) confirmed that an alternate menu is always available to residents 24 hours a day. This alternative menu, which provides flexibility in meal choices outside of the standard range, is posted at the food bar in the dining area. When asked about any reported issues or delays in food service on November 4, 2025, (A#1) confirmed that there were no delays or concerns reported. The menu for that date had been posted and distributed in advance, and meal service was carried out as scheduled.

On November 21, 2025, at approximately 10:00 am, interviews were conducted with residents (R#1 to R#9). (9) out of (9) reported that there were no delays in food service in the dining room during the week of November 4, 2025, and that they had not experienced any recent delays in receiving their meals. Additionally, (9) out of (9) residents confirmed that they receive the food menu each week, in accordance with the facility’s procedures for menu distribution.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20251105144029
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: 11/21/2025
NARRATIVE
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On November 6, 2025, at approximately 11:00 AM, interviews were conducted with facility staff (S#1–S#9), (9) out of (9) reported that meals were served on time on November 4, 2025, and that menus had been distributed to residents one week in advance, in line with the facility's standard procedures. Furthermore, (9) out of (9) staff explained that if a staff member is unable to fulfill a resident's food order due to an unexpected situation, another staff member is quickly assigned to assist the resident, ensuring that service continues without delay.

Allegation: Staff left resident unattended for an extended period of time

The details of the complaint alleged that a resident was left unattended in the dining room for approximately one hour.

On November 6, 2025, during an interview, Executive Director (A#1), LPA Iniguez inquired about the facility's supervision protocols for residents in common areas, particularly in the dining room. (A#1) confirmed that when residents are present in the dining room, staff members take note of their presence. Additionally, (A#1) mentioned that multiple staff members are present during mealtimes to ensure appropriate supervision and support. When asked if there had been any incidents or documentation regarding a resident being left unattended for an extended period, (A#1) stated that no such incidents have occurred and that residents are consistently monitored while in common areas.

On November 21, 2025, at around 10:00 AM, interviews were conducted with residents (R#1 to R#9), (9) out of (9) reported that they had never seen another resident left alone in the dining area for an extended period. Additionally, (9) out of (9) residents expressed that they felt safe while in the dining room, and there are always staff members present.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20251105144029
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: 11/21/2025
NARRATIVE
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On November 6, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1–S#9), (9) out of (9) confirmed that the dining staff are responsible for monitoring residents while they are in the dining area. They stated that it is an ongoing expectation to provide visual supervision of residents during mealtimes to ensure their safety and well-being. Furthermore, when asked if any staff had witnessed a resident being left alone in the dining room for an extended period, (9) out of (9) facility staff replied that they had never observed such an incident.

During this investigation, LPA did not find 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 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 Stephanie Walters/ Senior Executive Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4