<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 08/19/2022
Date Signed: 08/19/2022 08:47:48 AM

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
07/26/2022 and conducted by Evaluator Jey Cardenas
COMPLAINT CONTROL NUMBER: 11-AS-20220726145257
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: 24DATE:
08/19/2022
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Plan of Operations, Robert GarciaTIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was bit by another resident
Staff do not allow the resident to make phone calls
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jey Cardenas conducted subsequent complaint visit to the above facility to deliver findings. Upon arrival at the facility LPA meet with Assistant Director of Health Services, Marible Giron and Plan of operations Robert Garcia. LPA explained the reason for today’s visit and conducted a Covid-19 risk assessment, based on the assessment facility has no active covid-19 cases.

The investigation consisted of following: On 8/04/2022 LPA Cardenas made initial 10-day complaint visit to facility and interviewed staff#1- #8(S1-S8) / residents#1- #4 (R1-R4) R5 refused to be interviewed. LPA obtained staff and resident roaster and documentation pertinent to the complaint allegation.

It is being alleged that R1 was the victim of' a biting incident at the hands of another resident. In addition, R1 has been denied access to facility phone.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
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 2
Control Number 11-AS-20220726145257
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: 08/19/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued pg2)

Regarding allegation: Resident was bit by another resident; Per LPA record review of Unusual Incident Report (UIR) submitted to Community Care Licensing (CCLD); On 7/22/22 R1 and R2 both of who are diagnosed with dementia were involved in disagreement. R2 proceeded to grab R1s left arm, consequently, R1 suffered a bite and skin tear on arm. R1 was sent to Cedar Sinai. Appropriate parties were notified.

Per staff interviews: On 8/4/22 LPA interviewed Marissa who indicates that at approximately 9:45am There were eight (8) residents in the dinning-room, R1 told R2 to be quiet, R2 grabbed R1s arm and bit resident. R1 was sent to the hospital and treated for a skin tear. Residents have not been involved in previous altercations. LPA interviewed S2, staff states that the incident involving R1 and R2 happened in the morning during breakfast in the dining-room. S2 was feeding a resident and back was turned away from R1 and R2, incident happened fast, an exchange of words happened which alerted staff to check on R1 and R2. S2 went over to residents, separated them, and observed R1’s arm was injured. LPA interviewed S3-S8 who deny witnessing the altercation that occurred on 7/22/22 between R1 and R2. The majority of the staff interviewed have no knowledge of any physical altercations involving the residents. Per resident interviews; R1 stated that a few days ago during breakfast R1 was bit on the arm by another resident because R1 tapped other residents’ arm. The paramedics came and R1 was transported to the hospital. During interview with R2, resident was unable to recall the incident, denies being involved in any physical altercations with residents at the facility. R2 reported disliking other residents around in their space. R3 and R4 denied ever being involved or witnessing any resident on resident physical altercations. Per LPA observations; LPA observed R1 has a healing tears on left forearm, no stitching.

Regarding allegation: Staff do not allow the resident to make phone calls. Per staff interviews conducted; Executive Director Marissa and seven (7) out of seven (7) staff indicated that residents are allowed to use facility telephone to communicate with family, friends, or others. Some residents have and utilize their own cellphone to make calls. Facility has a tablet/laptop available for virtual calls, Facility landline and Nurse station cellphone is also available for residents to make calls. Staff schedule and set up virtual meetings or phone calls between residents and their loved ones. S4 stated that R1 is encouraged on a weekly basis to call family, however R1 refuses to make a call. Per resident interviews: R1 states that family/ friends have not called to check in on them. Therefore, R1 has not attempted to call their family from the facility. R1 states that they are allowed to use the facility phone. Recently, resident used facility phone to call doctor’s office. R2-R4 had no concerns regarding access to facility phone.

Based on LPA’s interviews and observation LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted and copy of this report and appeal rights provided to facility representative.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2