198320184-12-8-2023-11-AS-UCOL-CYBR6V-20231208114517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 08/31/2023
Date Signed: 12/08/2023 11:38:34 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
08/22/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230822080312

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: 40	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Jodi Kanowitz, Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility does not have adequate supplies to meet resident’s needs.
Resident’s personal belongings are not being safeguarded.
Staff are rough with residents in care.
Staff do not provide residents with linens.

INVESTIGATION FINDINGS:

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On 12/07/23 Licensing Program Analyst (LPA) Regina Cloyed conducted an unannounced complaint visit to deliver an amendment of the report delivered by LPA Leon on 08/31/23, the purpose of this amendment is to correct the results of interviews conducted with residents during the visit. This amendment does not change the investigation findings of Unsubstantiated. LPA Cloyd met with Executive Director Jodi Kanowitz, the purpose of the visit was explained, and a copy of this report was provided.

On 08/31/23 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent unannounced visit to the above facility to further investigate the above allegations. LPA was met by Jodi Kanowitz, Executive Director (S1), and the purpose of the visit was explained.

See: LIC9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230822080312

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: 08/31/2023

NARRATIVE

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The investigation consisted of the following:
On 08/30/23 LPA Leon toured the facility inside and out with Plant Operations staff Robert Garcia (S10), interviewed five (5) staff (S1-S5) and four (4) residents (R1-R4). LPA Leon requested and reviewed facility documents. On 08/31/23 LPA Leon conducted a subsequent visit and collected additional documents. LPA Leon interviewed facility nurse, Judy Arreaga (S9), via telephone, and further interviewed S1.

The investigation revealed the following:
Regarding the allegation: Facility does not have adequate supplies to meet resident’s needs. It has been alleged that the facility does not have an adequate amount of supplies to meet the resident's needs. On 08/30/23 LPA Leon observed one (1) storage room upstairs and one (1) storage room downstairs that contained ample supplies of items for the census of residents. LPA Leon interviewed five (5) staff members (S1-S5), all of which have denied the allegation. Additionally, on 08/31/23, LPA Leon requested, and reviewed, the past four (4) months of purchases through McKesson Medical-Surgical Supply Manager and have agreed that the list of supplies has met the standards set by California Code of Regulations 87625(a).According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated.

Regarding the allegation: Resident’s personal belongings are not being safeguarded. It has been alleged that the facility does not safeguard resident's belongings. On 08/30/23 LPA Leon requested a copy of the admissions agreement directly from the marketing director's office and observed a section located after "For Family to Complete: Health Documents", noting Title 22, Division 6 Health and Safety Code: Chapter 3.2 Residential Care Facilities for the Elderly - Article 02. Licensing 1569.153 - Theft and loss program; standards, property inventories and surrender of personal effects; secured areas along with client/resident personal property and valuables list (LIC621). In addition, LPA Leon interviewed four (4) residents (R1-R4), of which two (2) out of four (4) residents have denied the allegation and two (2) out of four (4) residents were not able to provide responses due to their medical condition. LPA Leon interviewed five (5) staff members, all of which have denied the allegation and have mentioned that they "request all families to tag their members' clothing, have worked here long enough to know which items belong to whom and if the item is unknown, it is brought to the med-tech desk which is later discussed about during the 'crossover' meeting which is held between each change of shift." Report Continues, see LIC9099C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20230822080312

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: 08/31/2023

NARRATIVE

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Additionally, LPA Leon has observed in the Activities of Daily Living log notes regarding residents' missing items, "please find" which shows concern regarding residents' personal belongings. According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated.

Regarding the allegation: Staff are rough with residents in care. It has been alleged that the facility staff are rough with residents during turning and diapering. On 08/30/23 LPA Leon interviewed five (5) staff (S1-S5) regarding the allegation. S1-S5 have denied the allegation and each have mentioned "not to agitate" the residents in any fashion. Additionally, LPA Leon interviewed four (4) residents (R1-R4). Two (2) out of four (4) residents have denied the allegation, one of which had mentioned "nobody has handled me roughly." and two (2) out of four (4) residents were not able to provide responses due to their medical condition. Noted is a witnessed resident abuse without a date or time. On 08/30/23 LPA Leon requested copies of training records from three (3) staff (S6-S8). On 08/31/23 LPA Leon reviewed the documents. The transportation training's were completed through the Relias program on 08/29/23; which, according to S1, are completed through in-staff training sessions conducted with S9. All three (3) staff are current with their CPR/First Aid and their Food Handling Certificate. Additionally, LPA Leon interviewed five (5) staff (S1-S5) regarding the above allegation and requested a walk-through as to how S1-S5 would relocate a resident. S1-S5 discussed and displayed proper lifting procedures such as "hooking my arms below their armpits" and "locking their legs in-line with mine". According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated.

Regarding the allegation: Staff do not provide residents with linens. It has been alleged that the bedding is not changed often enough. On 08/30/23 LPA Leon observed one (1) well stocked linen storage closet upstairs. On 08/31/23 LPA Leon observed one well stocked linen storage closet (1) downstairs. Each of these closets were located in the Western corner of the building. On 08/30/23 LPA Leon conducted wellness checks on four (4) residents' rooms (R1-R4), each of which were shown to have properly fitted and clean bedding. Report Continues, see LIC9099C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230822080312

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: 08/31/2023

NARRATIVE

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Additionally, four (4) out of five (5) staff (S1-S5) have denied the allegation. One staff (S5) did note that there was one (1) instance in which the facility did run out of bed linens, "possibly back in February", but since then that instance has never returned. Furthermore, LPA Leon conducted extended record review of the med-tech assignment book, which shows the requirements of the overnight staff (NOC) shift which requires various residents' laundry to be serviced. The AM/PM shower schedule of those residents are also listed, noting "all beddings to be changed on shower days and as needed if soiled".

According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated.

An exit interview was held with Lead Concierge, Charlene Gaona (S11), and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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