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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:09:14 PM

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
06/22/2022 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220622081934
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: 35DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Jodi KanowitzTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Resident sustained bruise while in care.
Staff did not properly supervise resident.
Staff did not ensure that medication was stored locked and inaccessible to resident.
Staff did not ensure that passageways are free from obstruction.
INVESTIGATION FINDINGS:
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On 05/19/23 Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Executive Director staff #7 (S7) Jodi Kanowitz. LPA conducted a risk assessment prior to entering the facility. LPA explained the purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: An initial 10-Day visit was on 06/23/22 with former Executive Director staff #1 (S1) Marissa Drinkhouse-Quintana and subsequent visit on 02/08/23 with Executive Director staff #7 (S7) Jodi Kanowitz. LPA conducted interviews with staff members and residents and an inspection of the facility’s physical plant for health and safety purposes. LPA also requested the following documentation: staff roster, resident roster, staff schedule, incident reports, resident #1 (R1) Admission Agreement, Contact/Face Sheet, Physician Report, Pre Placement Appraisal, Case/Progress Notes other pertinent records in associated with this complaint. (Evaluation Report continues on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
VISIT DATE: 05/19/2023
NARRATIVE
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A separate investigation was conducted by the Department of Social Services Investigation Bureau by Investigator Ryan Miles which included a review of medical records, photographs and interviews with facility staff, witnesses and medical professionals.

INVESTIGATION REVEALED THE FOLLOWING:
Allegation #2: Resident sustained injuries while in care.

The investigation revealed that Resident #1 (R1) was initially admitted to the facility on 02/01/22 and had multiple falls from February 2022 to May 2022. The following is (R1’s) dates of unwitnessed falls: 02/23/22, 03/07/22, 04/17/22, and mid-May 2022. Only one of these falls on 03/07/22 was reported to Community Care Licensing and the authorized representatives. The fall on 02/23/22 (R1) sustained a knee injury, on 03/07/22 (R1) sustained a laceration on the right eye and pain in the right shoulder and arm, 04/17/22 and mid-May 2022 (R1) had no medical attention. In accordance with (5 out of 7) care staff, (R1)'s first unwitnessed fall was considered a "fall risk" and the facility did not re-evaluate (R1) for appraisal "care" plan for “increased care and supervision.” Based on the feedback by (4 out of 7) care staff, (R1) needed a higher level of care with supervision, one-on-one care, or skilled nursing care. Medical records from Cedar Sinai dated 03/07/22 revealed (R1) sustained injuries from a “fall with right shoulder and right arm pain” “impact head-to-head” and “periorbital hematoma." There was no Residents Care Plan available for (R1) to incorporate into the investigation. Based on interviews and supporting documentation reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF CARE AND SUPERVISION: “Resident sustained injuries while care” is SUBSTANTIATED.

Allegation #3: Staff did not properly supervise resident.

Interviews conducted by investigator Miles with witnesses, and current, and former primary medical physicians revealed (R1) had “a lot of blood” present in every bowel movement from June 2, 2022, to June 6, 2022 (day of death). The facility retained (R1) in the facility when (R1) should have been hospitalized for the bleeding of the rectum and status change in health condition. According to (R1's) former primary physician witness #3 (W3), (R1) consuming the Milk of Magnesia or any medication left unattended for (R1) to ingest may have compromised (R1)’s health that could be the cause of bleeding of the rectum with bowel movement. It is more than likely the incident caused the rapid decline in (R1's) health condition.
(Evaluation Report continues on LIC 9099-C)
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
VISIT DATE: 05/19/2023
NARRATIVE
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Based on information of interviews and supporting documentation gathered, the preponderance of evidence standard has been met the facility failed to seek proper medical attention for (R1); therefore, the allegation of NEGLECT/LACK OF CARE AND SUPERVISION: “Staff did not properly supervise resident” is SUBSTANTIATED.

Allegation #4: Staff did not ensure that medication was stored locked and inaccessible to resident.

Interviews with authorized representatives witnesses #1-#2 (W1-W2) to (R1) received a phone call and facility documentation as evidence from med-tech staff #3 (S3) who discovered an “empty” bottle of Milk of Magnesia (medication) that was consumed by (R1). (Five out of seven) care staff interviewed declared that med-tech staff #2 (S2) who administered Milk of Magnesia to (R1) was responsible for leaving a bottle of Milk of Magnesia to (R1) “forgot” and left the bottle accessible to (R1) to ingest. According to (S2) on 06/01/22 during the evening time (S2) received instruction from LVN staff #4 (S4) to administer Milk of Magnesia to (R1) since (R1) was having a difficult time with bowel movement. (S2) admitted to Investigator Miles, (S2) administered the Milk of Magnesia to (R1) in the evening of 06/01/22 and “forgot” and left the bottle exposed in (R1’s) room unattended. (S2) only became aware of the empty bottle of Milk of Magnesia when discovered, and LVN staff #4 (S4) addressed the incident of (S2) leaving the medication in (R1's) room on 06/02/22. (S2) stated from 06/02/22 to 06/06/22 (R1’s) bowel movement had a presence of blood and that the rectal was bleeding. (S2) addressed the issue of (R1’s) bleeding to (S4) but did not do anything about it. (S2) claimed the facility did not seek proper medical attention for (R1’s) rectal bleeding and that management was aware of (R1’s) rapid decline of health. The Department reviewed the personnel file of (S2) on 02/10/23 and it revealed (S2) had only completed 14.60 hours of required training and did not complete the training on the “Effects of Medications on the Behavior of Resident with Dementia.” Based on (S2) admission for negligence for leaving medication accessible to (R1) and supporting documentation reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF CARE SUPERVISION: “Staff did not ensure that medication was stored locked and inaccessible to resident.” is SUBSTANTIATED.

(Evaluation Report continues on LIC 9099-C)
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
VISIT DATE: 05/19/2023
NARRATIVE
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Allegation #5: Staff did not ensure that passageways are free from obstruction.

It is alleged resident #1 (R1) was not accorded a safe environment and that the facility was not free from obstruction. The complainant reported on 02/23/22 (R1) sustained an injury when a laundry basket was left in the hallway that caused (R1) to fall over and sustained a knee injury. An interview was conducted on 09/07/22 by Investigator Miles with former Executive Director staff #1 (S1) who admitted that (R1) was considered a “fall risk” and had one witnessed fall and two unwitnessed falls in the facility. (S1) confessed with (R1's) first admission into the facility (R1) fell over a laundry basket in the hallway. (S1) admitted (R1) to being injured when the laundry basket blocked the passageway, and (R1) had to be taken to the hospital for treatment. Based on admission from (S1) and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF CARE AND SUPERVISION: “Staff did not ensure that passageways are free from obstruction” is SUBSTANTIATED.

Civil penalties are assessed for Five hundred Dollars ($500.00) for related sustained injuries due to falls and rectal bleeding for Resident #1.



According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies have been observed and citations issued (ref. LIC 9099D) and civil penalty assessed.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2023
Section Cited
CCR
87466
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87466 Observation of the Resident - The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... assistance is provided... When changes such as... deterioration of mental ability or a physical health condition... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician...
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Licensee/Administrator shall read Title 22, Section 87466 “Observation of the Resident” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 05/20/23.
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This requirement is not met as evidenced by: Based on records and interviews, the licensee failed to seek immediate medical attention for (R1) with rectal bleeding had progressed or unwitenssed falls with injuries. This violation poses an immediate health, safety, or personal rights risk to persons in care.

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IMMEDIATE CIVIL PENALTY
Type A
05/20/2023
Section Cited
CCR
87465(h)(2)
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87465 Incidental Medical and Dental Care
(h) The following requirements shall apply to medications...(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees...
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Licensee/Administrator shall read Title 22, Section 87465 “Incidental and Dental Care" and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 05/20/23.
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This requirement is not met as evidenced by: Based on interviews, (S2) left the Milk Magnesia out for (R1) to consume which may have lead to the decline in health. This violation poses an immediate health, safety, or personal rights risk to persons in care.
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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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2023
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 the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations...
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Licensee/Administrator shall read Title 22, Section 87468.1”Personal Rights of Residents..." and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 05/20/23.
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This requirement is not met as evidenced by: Based on records and interviews, the facility failed to accord a safe and healthful environment for (R1) in which cause mulitple falls and injuries. This violation poses an immediate health, safety, or personal rights risk to persons in care.

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Type B
06/02/2023
Section Cited
CCR
87211(a)(B)(D)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department... (B) Any serious injury... occurring while the resident is under facility supervision. (D) Any incident which threatens the welfare, safety, or health of any resident...
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Licensee/Administrator shall read Title 22, Section 87211 “Reporting Requirements” and send a written statement to CCLD that you have read and understand this section and report all resident's incidents. This plan is due to CCLD/El Segundo ASC Office by POC date of 06/02/23.
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This requirement is not met as evidenced by: Based on records and interviews, the facility failed to submit written report several falls and injuries of resident #1. This violation poses an immediate health, safety, or personal rights risk to persons in care.
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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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2023
Section Cited
CCR
87405(1)(2)
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87405 Administrator - Qualifications and Duties (b) The administrator of a facility.. shall have the responsibility and authority to carry out the policies... (1) Knowledge of the requirements for providing care and supervision... (2) Knowledge of and ability to conform to the applicable laws, rules, and regulations
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Licensee/Administrator shall read Title 22, Section 87405 “Administrator - Qualifications and Duties” and send a written statement to CCLD that you have read and understand this section. This plan is due to CCLD/El Segundo ASC Office by POC date of 06/02/23
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This requirement was not met as evidenced by: Based on observation record and interviews, the Administrator failed to adhere to Title 22 regulations, resulting to multiple deficiencies cited. This violation poses/posed a potential health, safety, or personal rights risk to persons in care.
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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: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 9
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
06/22/2022 and conducted by Evaluator Ernand Dabuet
COMPLAINT CONTROL NUMBER: 11-AS-20220622081934

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: 35DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Jodi KanowitzTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Suspicious Death.
Staff did not provide responsible party with documents.
INVESTIGATION FINDINGS:
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On 05/19/23 Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Executive Director staff #7 (S7) Jodi Kanowitz. LPA conducted a risk assessment prior to entering the facility. LPA explained the purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: An initial 10-Day visit was on 06/23/22 with former Executive Director staff #1 (S1) Marissa Drinkhouse-Quintana and subsequent visit on 02/08/23 with Executive Director staff #7 (S7) Jodi Kanowitz. LPA conducted interviews with staff members and residents and an inspection of the facility’s physical plant for health and safety purposes. LPA also requested the following documentation: staff roster, client roster, staff schedule, incident reports, resident #1 (R1) Admission Agreement, Contact/Face Sheet, Physician Report, Pre Placement Appraisal, Case/Progress Notes other pertinent records in associated with this complaint. (Evaluation Report continues on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 11-AS-20220622081934
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: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
VISIT DATE: 05/19/2023
NARRATIVE
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A separate investigation was conducted by the Department of Social Services Investigation Bureau by Investigator Ryan Miles which included a review of medical records, photographs and interviews with facility staff and medical professionals.

INVESTIGATION REVEALED THE FOLLOWING:



Allegation #1: Suspicious Death.
Interviews conducted by investigator Miles with the facility primary physician witness #4 (W4) stated in medical opinion, “Have no opinion of the consumption of Milk of Magnesia that could have caused the rapid decline in (R1)’s health. It may, however, have exacerbated (R1)'s situation or uncovered an underlying condition that was not diagnosed. The death certificate states that (R1) passed away as the result of Cardiopulmonary Arrest and Alzheimer's Disease. A medical autopsy was not performed to determine if Milk of Magnesia caused a "rapid decline" in (R1)'s health. Based on interviews conducted and supporting documents gathered, the allegation of “Suspicious Death" is Unsubstantiated.

Allegation #6: Staff did not provide responsible party with documents.
The details of the complaint indicated that the facility did not provide resident #1 (R1’s) facility records to the authorized representative. According to the complainant, the facility was unwilling to provide copies of records, and the facility still has not provided the records as of 05/19/23. An interview with the current executive director (S7) stated to be unaware of (R1’s) records ever made available to (R1’s) authorized representatives. Former executive director (S1) could not be reached for comment on this matter and did not return calls. The Department was in contact with the President staff # (S8) who was not able to verify if a written demand request was served. The facility nor authorized representatives can provide a written demand request as evidence. Based on interviews conducted and lack of supporting documents provided as evidence, the allegation of “Staff did not provide the responsible party with documents" is Unsubstantiated.

Based on the record reviews and interviews conducted, the Department found no evidence to support the allegations mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Jodi Kanowitz, and a copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 9 of 9