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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320184
Report Date: 05/03/2022
Date Signed: 05/03/2022 12:55:39 PM


Document Has Been Signed on 05/03/2022 12:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754



FACILITY NAME:AVENIR MEMORY CARE WESTSIDEFACILITY NUMBER:
198320184
ADMINISTRATOR:DRINKHOUSE-QUINTA, MARISSAFACILITY TYPE:
740
ADDRESS:7501 OSAGE AVETELEPHONE:
(424) 282-0040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:88CENSUS: 21DATE:
05/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Marissa Drinkhouse-QuintaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jeyde Cardenas conducted an unannounced case management visit to the above facility. Upon arrival LPA was met by front desk concierge, Ashley Abner, LPA explained the purpose of todays visit. Covid-19 risk assessment was conducted, facility is clear of Covid-19 infection. Administrator, Marissa Drinkhouse-Quintana assisted LPA with the visit.

On todays visit LPA interviewed administrator, Marissa, Staff#2 (S2), and met with Resident#1 (R1) who was eating breakfast in the dinning room and appear to be in good spirit. LPA Cardenas reviewed Staff #1 (S1) staff #2 (S2) and R1’s facility file. LPA accessed the video room and observed recording of the incident that took place on 4/19/2022 involving S1 and R1.

CCLD obtained SOC341/ incident report regarding alleged resident abuse incident; indicating that on 4/19/2022 S2 observed S1 hit R1. On 5/3/2022 LPA Cardenas interviewed administrator Marissa who indicates that R1’s medical diagnosis is Parkinsons and Dementia. Facility conducted Investigation into the alleged absue; S1 and S2 were interviewed regarding the incident; S1 was suspended to allow facility to conduct investigation. On that same day 4/20/2022, S1 resigned. On 5/3/2022 LPA was granted access to review the video footage and observed…

CCLD investigation ongoing. Exit interview held, no deficiencies cited during todays visit. A copy of the report was provided to facility representative.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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