198320184-7-7-2023-11-AS-MVAO-CUHU4D-20230808151459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 07/07/2023
Date Signed: 07/07/2023 03:32:15 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:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jodi Kanowitz		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff are not responding to resident's calls for assistance
Facility staff are mismanaging resident's medication
Residents have access to dangerous items/chemicals
Facility staff is not providing adequate food service to residents in care
Facility staff are not receiving proper training before providing care to residents
Facility staff is utilizing cameras inappropriately throughout the facility
Facility administrator does not have the proper qualifications
Facility staff are not ensuring kitchen is properly cleaned

INVESTIGATION FINDINGS:

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On 07/07/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a visit to deliver the findings for the allegations listed above. LPA met with Executive Director, Jodi Kanowitz, and the purpose of today's visit was explained.

The investigation consisted of: On 05/18/23, LPA conducted a facility tour, interviewed Executive Director, Director of Health Services, Director of Culinary Services, Plant Operation Director, staff (S1 and S2), document review of: Staff/Client Roster, 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.

Continued on LIC9099-C

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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 5

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: 07/07/2023

NARRATIVE

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On 06/16/23, LPA Interviewed Staff (S7-S10), and Residents (R1-R8), reviewed and received copies of Narcotic Count, and observed resident activities, and staff interaction with residents.

LPA's investigation revealed the following:

Allegation: Facility Staff are not responding to resident’s call for assistance
The details of the complaint alleged that Director of Health Services does not respond to emergency calls from staff on duty. During interviews with staff (S3 S4, and S6-S9), seven out of seven staff stated Director of Health Services (S2) always answer their calls when there is an emergency, no matter the day or time. Staff also stated S1 and S2 come in when needed.
During interviews with staff (S1, S2, and S6-S9), six out of six staff stated when a resident comes for help or calls for assistance, staff goes right away to check on resident. Interviews with Residents (R1-R8), eight out of eight residents stated their calls and requests for assistance are met within a timely manner. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Facility staff are mismanaging resident’s medications

The details of the complaint alleged that medications are not being passed correctly and narcotics are not being counted. During record review, LPA reviewed residents Medication Administration Records (MARs) and medications for 10 residents. Ten out of ten resident’s MARs and medication are consistent with properly documented records. LPA reviewed five residents Controlled Drug Records and prescribed narcotic medication, five out of five medications were counted and were consistent the Controlled Drug Records. LPA interviewed Staff (S2 & S6) two out of two staff stated all narcotic medications are counted at the beginning and ending of each shift. LPA interviewed 8 Residents (R1-R8), and eight out of eight residents stated they receive their medications daily and on time. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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: 07/07/2023

NARRATIVE

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Allegation: Resident have access to dangerous item/chemicals

The details of the complaint alleged that residents could access harmful chemical because they are not being locked away after use. During tour of the facility, LPA did not observe any chemicals accessible to residents. LPA did observe the storage closet where chemicals are stored and to gain access to it you must go through three locked doors, that require an access code. LPA observed an empty bottle of disinfecting wipes in a high locked cabinet in the Bistro area. LPA inspected housekeeping cart to observe how chemicals are stored and kept inaccessible to residents. Staff (S10) showed LPA that the caddy where chemicals are stored is locked. Staff open the caddy remove the chemical they are going to use and relock it before entering room they are cleaning. Staff (S10) informed LPA that while cleaning, only one chemical is used at a time, and it is always in their hand. When they need their next product they unlock the caddy, put away the one in hand, get the next product, close, and relock the caddy. LPA interviews with Staff (S3-S10), eight out of eight stated they have not seen any dangerous chemicals left out or accessible to residents. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Allegation: Facility staff is not providing adequate food service to residents in care.

The details of the complaint alleged that residents are not being provided snacks.

During facility tour, LPA observed snacks (sandwiches, fresh fruit, Jell-o, pudding, chips, cookies, and granola bars) and drinks (water, juice, soda, and coffee) in the upstairs Bistro area available for residents. LPA observed additional snacks in the downstairs Bistro refrigerator to be used for staff to refill the upstairs Bistro. Administrator informed LPA the Bistro is filled and refilled throughout the day, and snacks and drinks are available for residents at any time of the day. LPA interviews with Staff (S4-S9), six out of six staff stated, residents are given 3 meals a day and snacks are available all day long. LPA interviewed Residents (R1-R8), eight out of eight residents stated they receive their meals daily and on time and snacks are available in the Bistro. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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: 07/07/2023

NARRATIVE

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Allegation: Facility staff are not receiving proper training before providing care to residents

The details of the complaint alleged that new staff are working on the floor without completing proper training. LPA reviewed and received copies of training for new staff hired after 02/24/23. All staff have had 40 hours of training on Relias and 20-40 hours of shadowing before working on the floor. LPA reviewed additional In-service training logs that are conducted monthly. LPA interviewed Administrator (S1), who stated all new hires are required to complete 40 hours on Relias and 20 hours shadowing before they work on the floor with residents. S1 stated In-Services are done monthly and include topics of Care of Residents with Dementia, Medication Interactions, Infection Control, Mandated Reporting and Abuse, Home Health Care, Sexual Behaviors, End of Life Options, Use and Storing Chemicals, and much more. Interviews with Staff (S1-S4), four out of four staff stated they attend in-service training or conduct in-service training. Interviews with Staff (S5-S10) stated they completed 40 initial hours on Relias, 20-40 hours of shadowing, and do continued training on Relias, and attend regular in-services. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Allegation: Facility staff are utilizing cameras inappropriately throughout the facility

The details of the complaint alleged that current administrator is using cameras in the facility with sound. Additionally, recordings are not being deleted and are being saved. LPA viewed video recordings and did not hear audio. LPA reviewed video feed; all surveillance cameras are in common spaces. Use of surveillance cameras was added to the plan of operations submitted to CCL on 06/21/23. It is addressed in the admission packet so new residents and families are aware recording is in progress. Additionally in the employee packet staff are informed surveillance is in progress. When you enter the facility there is a sign posted that informs you surveillance video recording in progress. Interviews with Staff S3 stated the recordings are kept up to 45-hours, possibly less depending how often the cameras are activated by motion. The recordings are then recycled after approximately 45-hours. S3 stated no sound is recorded and recording is only in common areas. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

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: 07/07/2023

NARRATIVE

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Allegation: Facility administrator does not have the proper qualifications

The details of the complaint alleged that the administrator is not qualified to run the community. DSS does not have her credentials. During the visit LPA reviewed the administrator’s qualifications. LPA reviewed S1’s Administrator Certificate, current Health Screening, LIC508 Criminal Background Record Statement, and resume with education and experience. Based on file review, the Administrator is qualified and has the credentials to be the Administrator. During interview with Administrator (S1), stated a Change of Administrator was submitted to Community Care Licensing on September 22, 2022. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Allegation: Facility staff are not ensuring kitchen is properly cleaned

The details of the complaint alleged that kitchen is unsanitary for food preparation. During the facility tour, LPA and LPM observed the kitchen to be clean and sanitary. LPA reviewed the facilities Kitchen Daily Cleaning Schedule initialed by staff when a task is completed. Interviews with staff (S4 and S5), two out of two staff stated the kitchen is cleaned after every food preparation. Staff S4 and S5 stated they clean as they go and ensure the Kitchen Daily Cleaning Schedule is completed. S5 stated the general rule is if you see it, clean it. During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

There were no deficienis cited during today's.

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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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