198320184-9-27-2022-11-AS-MVAO-CVTM6C-20230919091937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 09/26/2022
Date Signed: 09/27/2022 08:47:31 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/16/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220916154424

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: 23	DATE:	09/26/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	JUDY ARREAGA		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is not kept in clean, sanitary conditions for residents

INVESTIGATION FINDINGS:

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On 9/26/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. Upon arrival, LPA called the facility to conduct a risk assessment. LPA spoke with Director of Sales and Marketing, Cari Ramos, who confirmed the facility is Covid-19 free. LPA met with Cari Ramos and Jacqueline Vu, The Business Office Manager shortly after and LPA explained the purpose of today's visit. Vu introduced LPA to the Director of Health Services, Judy Arreaga, who assisted LPA with the visit.

The investigation consisted of the following: LPA toured the facility. LPA attempted to interview two residents (R1-R2) but they refused to talk. LPA interviewed four (4) residents and four (4) staff. LPA requested and obtained copies of Resident #1's service records (Admission Agreement, Physician's Report, Appraisals, and Medication Administration Records -MAR), Staff Roster and Resident Roster. LPA also requested copies of four residents' (R3-R6) MAR.

Report continued in LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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-20220916154424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 09/26/2022

NARRATIVE

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Investigation consisted of the following.

Allegation: Facility is not kept in clean, sanitary conditions for residents.

It is alleged that facility is not kept clean and sanitary. The Reporting Party (RP) alleged the facility is unsanitary in resident bedrooms, bathrooms, and hallways. RP stated the floors and walls in the hallways all have stains from feces and smells of urine all over the facility. During interview, S1 stated some rooms are clean and some rooms could be better. S1 stated since she began working at this facility, there hasn’t been any housekeeper instead the caregivers are expected to clean the resident bedrooms and all other staff are expected to clean up as they observe any mess in the facility. Based on LPA’s interview with S2, S3 and S4, it was revealed that the common areas are clean with some breadcrumbs on the floor, some resident bedrooms are left dirty when there’s not enough staff to clean. Residents (R1-R2) refused the interview while residents (R3-R6) were not able to maintain a proper conversation. Based on LPA’s observation, some bedrooms are clean, and some bedrooms are dirty, filthy, and unsanitary. LPA observed old looking feces in the toilet bowl and feces are smudged around the toilet bowl in resident bedrooms # 2001, #2002, #2005, #2020. LPA smelled strong urine and foul smelling feces in these bedrooms. LPA observed feces smudged around the closet inside resident bedroom # 2001 and smelled urine all over the bedroom. LPA observed broken closet doors in resident bedrooms. LPA also observed broken bed frame in bedroom # 2025, broken closet doors, toilet cover, bedrail in bedroom # 2022, unrepaired bathroom ceiling in bedroom 2005 and broken closet door in bedroom # 2002 and missing closet doors in some resident bedrooms. Based on LPA’s interviews and observation, there is sufficient evidence to corroborate the above allegation.

Based on LPA observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted and Appeal Rights was discussed with Director of Health Services, Judy Arreaga. A hard copy of the report and Appeal Rights were provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220916154424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/27/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	The licensee shall ensure all areas of the facility is clean, safe and sanitary. The licensee shall clean and sanitize resident bedrooms #2001, 2002, 2005, 2020, 2022 and all areas of the facility that are dirty and unsanitary. Licensee shall repair all broken closet doors and replace missing closet doors and ensure the facility is in good repair at all times.This was corrected during the visit.
	8 9 10 11 12 13 14	Based on LPA’s observations and photos taken, some areas of the facility are clean and in order but some bedrooms are dirty, filthy, and unsanitary. LPA observed old, dark feces in toilet bowls and feces are smudged around the toilet bowls in resident bedrooms # 2001, #2002, #2005, #2020. LPA smelled strong urine and disgusting feces smell in these bedrooms. LPA observed feces smudged around the closet inside resident bedroom # 2001. In resident bedrooms #2001 and 2002, LPA smelled very strong and foul urine smell all over the bedroom and LPA observed urine spells all over the floor. LPA observed broken closet doors in resident bedrooms. LPA also observed broken bed frame in bedroom # 2025, broken closet doors, toilet over, bedrail in bedroom # 2022, unrepaired bathroom ceiling in bedroom 2005 and broken closet door in bedroom # 2002 and missing closet doors in someresident bedrooms. This poses an immediate risk to residents health, safety and/or personal rights.	8 9 10 11 12 13 14
CCR	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC9099 (FAS) - (06/04)

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