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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:41:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/02/2021 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211202092349
FACILITY NAME:WATERMARK AT WESTWOOD VILLAGE, THEFACILITY NUMBER:
198320127
ADMINISTRATOR:MURPHY, PATRICIAFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:237CENSUS: 36DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Acting Adminstrator, Amber Hernandez TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility does not have an Emergency Disaster Plan.
Facility is not following COVID-19 guidelines.
INVESTIGATION FINDINGS:
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On 02/09/2022 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA Agard met with Amber Hernandez, Acting Administrator and explained the purpose of this visit was to gather information regarding this complaint.

The investigation consisted of the following: On 12/07/2021, LPA conducted an initial 10-day visit and met with Acting Administrator, Patrick Raab. LPA completed interviews and requested copies of the following records. 1) Staff Roster, 2) Resident Roster w/ their responsible party, 3) A copy of Disaster Plan, 4) Schedule for November and December, 5) Weekly Covid Testing, 6) Emergency Drills. Some documents were received during the visit. The remaining documents were received on or before 12/08/2021.

On 02/09/2021 LPA Agard delivered findings.

Cont. 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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-20211202092349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 02/09/2022
NARRATIVE
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Regarding the allegation: Facility does not have an Emergency Disaster Plan. It’s being alleged “in the event of an emergency, residents who are deemed non-ambulatory by their medical doctor are unable to safely descent from the stairwells, there are no evacuation chairs in place on any floor. An Emergency Preparedness Manual is unavailable for staff that provide 24-hour care and/or supervision in the event that there is no management in the community at the time of a potential emergency. Lastly, associates have not underwent any fire, safety, earthquake, and elopement drills.” The investigation revealed the following: During interviews with staff, 5 out of the 6 confirmed this allegation to be true. 1 of the 6 denied the allegation to be true. 5 staff have confirmed either not receiving training on the Emergency Disaster Plan and/or taking part in an actual drill. S1 states, “we do have one, the current plan states to shelter in place. We don’t have evacuation chairs. We have ordered some. S1 states “I don’t know if the associates have been trained on the plan.”

During interviews with residents: 7 out of 7 confirmed this allegation to be true. All residents’ state not being aware of the facility’s Emergency Disaster Plan, being trained on what to do in the event of an emergency disaster or taking part in a drill. R1 states, “I have not been trained on what to do in the event of an emergency. There have been no fire drills. There are clearly marked signs for the exit, but I have not been introduced and they did not tell me what to do or where to go in an earthquake.” R3 states, “no, we were not, and I was not provided information on how to use the building, where safety equipment is located and certainly not the evacuation plan.”

During interviews with witnesses: 2 out of 2 confirmed this allegation to be true. W1 states, “I’m not aware about what the facility would do in the event of an emergency. They did not tell me or R1.” W2 states, “I don’t know what Watermark’s evacuation plan is in the event of an emergency.” During a review of records, LPA observed a disaster plan originally dated from the time of the facility’s pre-licensing inspection. However, there are no records available to LPA which confirms training has been conducted for staff on the facility’s disaster plan. Facility has no records of drills prior to complaint.

Regarding the allegation: Facility is not following COVID-19 guidelines. It’s being alleged associates who have been exempt from their MD or for religious reasons are not being COVID tested weekly per LA County. The investigation revealed the following: During interviews with staff, the Acting Administrator confirmed that some facility staff that are not vaccinated were not being tested weekly. “We have 2 staff with exemptions that Cont. 9099C


SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20211202092349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 02/09/2022
NARRATIVE
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were not being tested weekly.” S4 confirmed this allegation to be true. They don’t check the family members that come through the parking garage and go straight to the family’s room. Even the move-ins bypass the check point. They don’t show their vaccination card or sign-in. I also know there are certain staff that are not vaccinated that are not being tested.”

During interviews with residents, no resident could confirm the allegation to be completely true or false. No resident was able to confirm if unvaccinated staff were being tested weekly. During interviews with witnesses, no witnesses could confirm the allegation to be true or false. During a record review, LPA observed 2 staff with medical/religious exemptions that were last tested Sept 2021 & October 2021, respectively.

Based on the investigators interviews with Acting Administrator, staff, residents, witnesses and a record review, the preponderance of evidence standard has been met, therefore the above allegations is found to be Substantiated. California Code of Regulations, Title 22 Division (6) and Chapter (8) are being cited on the attached LIC9099-D.



An exit interview was conducted, and a hard copy was provided with appeal rights.
See LIC 9009-D on the next page.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20211202092349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2022
Section Cited
CCR
87705(c)(2)
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87705 Care of Persons with Dementia. Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(2) The Emergency Disaster Plan, as required in Section 87212, addresses the safety of residents with dementia.

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Facility will update their Emergency Disaster Plan and ensure staff and capable residents are trained by POC due date. Proof of training must be submitted to LPA via email.
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This requirement was not met as evidence by: Based on interviews and record review the facility failed to adhere to Title 22. Facility did not train staff or capable community members on the Emergency Disaster Plan.
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Type B
03/02/2022
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Facility will ensure unvaccinated staff are being tested regularly and submit evidence to licensing by POC due date. Proof of testing must be submitted to LPA via email.
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This requirement was not met as evidence by: Based on interviews and record review the facility failed to adhere to Title 22. Facility staff were not testing unvaccinated staff per PIN 21-32.1 ASC
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4