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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:28:54 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
12/01/2022 and conducted by Evaluator David Espana
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221201130811
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: 97DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lilit E. Mnatsakanyan, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility did not follow Covid-19 protocols.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 01/12/2023.**

On 10/06/2023 Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA met with Lilit E. Mnatsakanyan, Administrator and explained the purpose of this visit was to deliver findings for this complaint.
The investigation consisted of the following: On 12/05/2022 between 9:30am to 2:48pm, LPA conducted an initial 10-day visit and met with Resident Care Service Director, Kimberly Davis. LPA conducted a tour of the facility. On 12/05/2022 and 01/11/2023 between the hours of 10:12am - 3:00pm LPA completed interviews, requested, and reviewed copies of records. Documents were received at the time of visit.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
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 5
Control Number 11-AS-20221201130811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 10/06/2023
NARRATIVE
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The investigation revealed the following… regarding the allegation: Facility did not follow Covid-19 protocols. It’s being alleged “the facility had Covid-19 cases that were not reported to the proper agencies, the facility refused to test staff and residents, stop visitation and enforce masking for outside visitors.” LPA interviewed 7 out of 75 residents in total. 1 out of 7 residents confirm the allegation. During interviews with staff, LPA interviewed 7 out of 70 in total. 1 out of 7 confirm this allegation. During a record review on 12/02/2022, after receiving information of a possible Covid-19 outbreak, LPA Agard contacted the facility regarding the allegation. At that time, the acting Administrator confirmed there had been positive Covid-19 cases that were not reported to Community Care Licensing. On 12/02/2022, LPA Agard completed a Covid-19 intake for 3 Residents and 3 Associates.


Regarding the allegation: Facility is in disrepair. It’s being alleged that the facility has incomplete wiring in some apartments, lifters in the patio that are loose, leaks in the building, and elevators not running on various occasions. 0 out of 7 residents were able to confirm the allegation. During interviews with staff, 5 out of 7 confirmed this allegation. S2 states, “not being aware of any leaks or wires being exposed. All the elevators are working. The patio is up for repair.” During a facility tour on 12/05/2022 and 01/11/2023, LPA observed the lifters in the center of the courtyard to be caving inward. This section is identified by tape and small safety cones.

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

Licensing Program Analyst (LPA) David España conducted an exit interview and a hard copy was provided with appeal rights to Lilit E. Mnatsakanyan, Administrator.

See LIC 9099-D on the next page
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20221201130811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
Section Cited
CCR
87211(a)(2)
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Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.
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The administrator will create a plan to ensure future compliance to Tite 22 Regulation 87211(a)(2) Reporting Requirements. Proof of correction will be submitted to the department via email at David.espana@dss.ca.gov.
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This requirement was not met as evidence by: during an interview with the acting Administrator, it was revealed he did not report 6 positive covid-19 cases to licensing. This poses a potential health and safety risk to residents in care.
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Type B
10/20/2023
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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The administrator will create a plan to ensure future compliance to Title 22 Regulation 87303(a) Maintenance and Operation. Proof of correction will be submitted to the department via email at David.espana@dss.ca.gov.
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This requirement was not met as evidence by: observation of the patio being in disrepair due to the ground lifters caving inward.
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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: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
12/01/2022 and conducted by Evaluator David Espana
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221201130811

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: 97DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lilit E. Mnatsakanyan, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have an emergency disaster plan.
Facility does not provide a safe environment for residents.
Facility staff is not following safe food handling practices.
Facility staff does not maintain accurate resident paperwork.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 01/12/2023.**

On 10/06/2023 then Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA met with Lilit E. Mnatsakanyan, Administrator and explained the purpose of this visit was to deliver findings for this complaint. The investigation consisted of the following: On 12/05/2022 between 9:30am to 2:48pm, LPA conducted an initial 10-day visit and met with Resident Care Service Director, Kimberly Davis. LPA conducted a tour of the facility. On 12/05/2022 and 01/11/2023 between the hours of 10:12am - 3:00pm LPA Agard completed interviews, requested, and reviewed copies of records. Documents were received at the time of visit.

See LIC 9009-C on the next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20221201130811
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 10/06/2023
NARRATIVE
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5
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Regarding the allegation: Facility does not have an emergency disaster plan. It’s being alleged the community may not have an emergency binder in place. Staff or residents may not know what the procedures are during an Emergency.” 2 out of 7 residents confirm the allegation. All residents unanimously agree that they are unaware if the facility has a physical hard copy of a disaster plan, but 5 residents confirmed being trained on what to do in the event of an emergency. During interviews with staff, 1 out of 7 confirmed this allegation. During a record review, LPA Agard reviewed and confirmed facility’s disaster plan.

Regarding the allegation: Facility does not provide a safe environment for residents. It’s being alleged “the community has no security during the day and there have been various occasions homeless have entered the community putting the residents in danger.” 0 out of 7 residents confirmed the allegation. Residents denied feeling unsafe and reported there is a security guard outside at nighttime. During interviews with staff, 1 out of 7 confirmed this allegation. S2 states, there is concierge 24/7 and security from 7pm-7am.

Regarding the allegation: Facility staff is not following safe food handling practices. It’s being alleged the kitchen prepares and distributes/serves meals without wearing gloves or hair nets.” 0 out of 7 residents confirm the allegation. Residents reported no safety concerns with the way their food is being handled. During interviews with staff, 1 out of 7 confirmed this allegation. During a visit on 12/05/2021 and 01/11/2023, LPA observed kitchen staff wearing gloves, a hairnet or chef’s hat.

Regarding the allegation: Facility staff does not maintain accurate resident paperwork. It’s being alleged “residents are allowed to move in without their paperwork being complete.” 0 out of 7 residents confirm the allegation. All residents interviewed unanimously agreed not being aware of the specifics of this allegation and assume the facility has all the necessary paperwork for their file. During interviews with staff, 2 out of 7 confirm this allegation. During a visit on 12/05/2021 and 01/11/2023, LPA conducted a sample record review of resident files and found no records missing. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. Licensing Program Analyst (LPA) David España conducted an exit interview and a hard copy of the report was provided with appeal rights to Lilit E. Mnatsakanyan, Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5