198320184-6-2-2023-11-AS-RORN-CTFTQX-20230705145640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 06/02/2023
Date Signed: 06/02/2023 02:15:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
05/26/2023 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230526094518

FACILITY NAME:	AVENIR MEMORY CARE WESTSIDE		FACILITY NUMBER:	198320184
ADMINISTRATOR:	JODI KANOWITZ		FACILITY TYPE:	740
ADDRESS:	7501 OSAGE AVE		TELEPHONE:	(424) 282-0040
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	88	CENSUS: 34	DATE:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jacqueline Vu Business Office Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility emergency door is locked with a bolt.

INVESTIGATION FINDINGS:

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On 6/02/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced subsequent visit at the facility listed above to deliver findings. LPA arrived at facility and was greeted by Jacqueline Vu Business Office Manager. LPA explained the purposed of the visit is to deliver findings on the allegations listed above.

The Investigation consisted of the following:

LPA observed facility, as well as common areas of the facility. A comfortable temperature is maintained throughout the facility. LPA observed the facility to be operational and in good repair, LPA reviewed pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, documentation of fire drills, fire clearance and fire inspection logs on 06/01/2023. On 06/1/2023 LPA Randle interviewed Judy Arreaga Director of Health Services (S1). LPA and S1 toured the entire facility as it pertains to all fire doors and exits in the case of an emergency or fire where staff or residents had to evacuate the facility.
Con't on next page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230526094518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 06/02/2023

NARRATIVE

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Continued from page 1

LPA observed two main fire exits leading from the second floor to the exit doors on the first floor, LPA tested all emergency doors and door releases of the facility including delayed releases. LPA determined all doors were operational and effective at the time of testing. LPA interviewed staff (S2-S9) regarding allegation listed above on 6/01/23.

Investigation Revealed the following.

Allegation: Facility emergency door is locked with a bolt.

Regarding Allegation #1: Facility emergency door is locked with a bolt.

LPA Randle interviewed staff S1, S1 denied the allegation Facility emergency door is locked with a bolt. S1 toured the facility with LPA during unannounced visit, at the time of inspection there was no bolt present in any of the exit doors. LPA and S1 did observe a hole drilled into the push bar of one of the door releases on the bottom floor, S/W exit La Tijera Street, however there was no obstruction, the door operated without resistance for egress. LPA noticed the door was fitted with egress alarms that notified the front desk when activated. LPA interviewed Robert Garcia Director of Plant Operations (S2), denied the allegation Facility emergency door is locked with a bolt.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230526094518

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 06/02/2023

NARRATIVE

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Continued from page 2
S2 toured the exits of facility with LPA during unannounced visit, at the time of inspection there was no bolt present in any of the exit doors. LPA and S2 did observe a hole drilled into the push bar of one of the door releases on the bottom floor, (S/W exit door La Tijera Street), however there was no obstruction, the door operated without resistance for egress. S2 stated that he never noticed the hole since he has been employed more than a year. LPA interviewed staff (3-9) regarding complaint, all denied the allegation Facility emergency door is locked with a bolt. All staff interviewed denied ever seeing the door locked or locked with a bolt or having a problem with egressing from the building. Staff members 3 through 9 denied the allegation.

Findings

Based on information gathered, the department did not find sufficient evidence to support allegation Facility emergency door is locked with a bolt.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found insufficient evidence to support the allegations:Facility emergency door is locked with a bolt. The allegations may have happened or are valid, however there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Jacqueline Vu Business Office Manager. and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

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