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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 12/30/2024
Date Signed: 12/30/2024 11:23:00 AM

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
12/27/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241227134058
FACILITY NAME:WATERMARK AT WESTWOOD VILLAGE, THEFACILITY NUMBER:
198320127
ADMINISTRATOR:STEPHANIE KOFFMANFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:237CENSUS: 100DATE:
12/30/2024
UNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Stephanie Koffman-Senior Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff transported clients while under the influence of marijuana.
INVESTIGATION FINDINGS:
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On 12/30/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Stephanie Koffman / Senior Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#6) and Resident’s interviews (R#1-R#5). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, copies of November and December resident outing sign up list.


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: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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 3
Control Number 11-AS-20241227134058
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: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 12/30/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff transported clients while under the influence of marijuana.


The details of the complaint alleged that facility driver transported residents while under the influence of marihuana.


During the records review, LPA Iniguez observed the names of the residents who had driven by (S#1) in the past month and interviewed those residents.



During an interview with the administrator (A#1), she stated that the facility has five facility staff who drive the residents in the facility cars (2). In addition, (A#1) stated that she has never received a complaint from residents or staff regarding (S#1) driving under the influence of marijuana.

During interviews with residents (R#1-R#5), (4) out of (5) stated that they had never seen or smelled marijuana or cigarettes while riding with (S#1).

During interviews with staff (S#1), they state that they have never been under the influence of marihuana while at work or driving the residents in care.

During interviews with facility staff (S#2-S#6), (4) out of (5) stated that they had never seen or noticed (S#1) smoking or under the influence of marihuana while at work. On the other hand, (1) out of (5) staff stated that they have heard from another staff that (S#1) uses marihuana while at work.

Evaluation Report continues LIC 9099-C

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

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241227134058
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: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 12/30/2024
NARRATIVE
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During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

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 allegation(s) 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 Koffman-Senior Executive Director.



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

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3