198320184-6-16-2023-11-AS-MVAO-CUHU4E-20230808151459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 06/16/2023
Date Signed: 06/16/2023 04:57:49 PM

Unsubstantiated

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
05/10/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20230510094342

FACILITY NAME:	AVENIR MEMORY CARE WESTSIDE		FACILITY NUMBER:	198320184
ADMINISTRATOR:	DRINKHOUSE-QUINTA, MARISSA		FACILITY TYPE:	740
ADDRESS:	7501 OSAGE AVE		TELEPHONE:	(424) 282-0040
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	88	CENSUS: 36	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jodi Kanowitz		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff are not appropriately addressing outbreaks
Residents are not receiving appropriate medical care
Facility staff are not properly reporting incidents

INVESTIGATION FINDINGS:

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On 06/16/23, Licensing Program Analyst (LPA), Wendy Gibbs, and Licensing Program Manager (LPM), Eva Alvarez, conducted a subsequent complaint investigation visit. LPA met with Executive Director, Jodi Kanowitz, and explained the purpose of today’s visit.
Today’s investigation consisted of: Interviewing Staff (S7-S10), and Residents (R1-R8), review and received copies of Narcotic Count, and observation of resident activities, and staff interaction with residents.
Today was a subsequent visit to 05/18/23, to continue interviews of staff and aquire additional documentation pertinent to the investigation. The first initial 10-day visit consisted of: facility tour, interview of Executive Director, Director of Health Services, Director of Culinary Services, Plant Operation Director, staff (S1 and S2), document review of: Resident Physician Reports, Nurse Notes, Plan of Operation , Infection Control Plan, Incident Reports for the past 3 months, Procedure for responding to calls, procedure for storing dangerous chemical and items, Menu, Special diet orders, nutritionist report, procedure for cleaning kitchen, and Training logs for new hires, outbreaks, incident reporting, storing and using dangerous chemicals and items, responding to call buttons, and medication distribution and storage

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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 4

Control Number 11-AS-20230510094342

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: 06/16/2023

NARRATIVE

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Allegation: Facility staff are not appropriately addressing outbreaks
The details of the complaint alleged that the facility has had cases of a communicable disease and residents are not properly being treated for current symptoms
LPA interviewed Staff (S1, S2, S6, & S7), all staff stated Residents are monitored and checked for any change of conditions regularly. Four out of Four staff (S1, S2, S6 & S7) interviewed have said they have been trained on infection control and implementing infection control measures that consist of donning and doffing PPEs, regularly sanitizing common areas and staff monitor residents and conduct hourly rounds. During a review of Nurse documentation and records, LPA found 4 cases of a communicable disease had occurred in the facility and were reported to Licensing and DPH on 2/16/21,03/10/23, and two on 03/21/23. The 1^st case reported was on 02/16/23 and the last on 03/21/23. LPA reviewed the facilities Infection Control Plan, and Mitigation Plan for communicable diseases dated 11/10/22. During record review, LPA found procedure from both plans were followed, and measures were taken to control the spread and treatment was provided to those residents per physician’s orders. LPA reviewed resident’s files, and care notes and observed residents received care and treatment in a timely manner. LPA interviewed Resident’s (R1-R8), and all expressed that the facility is taking the necessary measures when infection control is needed.

Based on interviews, record review, and observation LPA was unable to find evidence to support the above allegation.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Allegation: Residents are not receiving appropriate medical care

The details of the complaint alleged that residents with a communicable disease are not being treated.
Interview with Director of Health Services and Facility Nurse, Judy Arreaga (S2) stated oral and topical medications were administered per physicians’ orders, and residents were continually assessed by a physician and S2. S2 monitored residents’ progression of condition and was in communication with the facility physician and resident families to provide health status updates of the resident. Per S2 notes staff ensured resident’s care plan was followed and documented progression of resident’s condition. Upon Resident’s record review from 02/01/23 to 05/18/23, residents were administered treatment in a timely manner. Records are consistent with the documented care provided. During interviews, Eight out of eight residents stated they received treatment as necessary and as ordered when a communicable disease is

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230510094342

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: 06/16/2023

NARRATIVE

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present in the facility. During interviews with Staff (S1,S2,S6 & S7) four out of four stated residents care was given in a timely manner and per physicians orders.

Based on interviews, record review, and observation LPA was unable to find evidence to support the above allegation.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Allegation: Facility are not properly reporting incidents

The details of the complaint alleged that facility is not reporting incidents and staff are being instructed not to report incidents

During interview with Executive Director (S1), they stated all incidents are documented and reported to CCL and if necessary additional agencies. During interviews with Staff (S2, & S6-S10) six out of six staff stated they report all incidents to Executive Director S1), Director of Health Services (S2), Med Techs, and/or other designated authorities. Additionally, six out of six staff interviewed stated they have never been told not to report an incident and they are told to report all incidents no matter how minor. LPA reviewed and received copies of Incident Reports from 02/16/23 to 05/18/23. During file review of incident reports LPA matched them to Special Incident Reports (SIR) reports that were submitted to CCL. Additionally, LPA reviewed and received a copy of a Resident’s (R2) care notes, selected an incident, and asked to match the Special Incident Report submitted.

Based on interviews, record review, and observation LPA was unable to find evidence to support the above allegation.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Executive Director, Jodi Kanowitz, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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