198320184-10-30-2024-11-AS-JHAD-DAS2BL-20241106161519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 10/30/2024
Date Signed: 10/30/2024 06:27:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241028134758

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: 57	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	10:59 AM
MET WITH:	Terri Weitzman		TIME COMPLETED:	04:11 PM

ALLEGATION(S):

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Staff did not allow resident to have visitors.

INVESTIGATION FINDINGS:

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On 10/30/24, the Department conducted an unannounced complaint visit at this facility. The Community Care Licensing (CCL) associate was greeted by Executive Director Staff #5 (S5: Terri Weitzman). CCL associate explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following: A health and safety inspection. A review of Resigister of Facility Residents LIC 9020 (dated: 10/29/24), Personnel Report LIC 500 (dated: 10/23/24), Admissions Agreement and Contract (dated: 06/17/24), Resident Handbook (dated: 06/17/24), Physicians Report LIC 602A (dated: 06/13/24), Preplacement Appraisal Information LIC 603A (date: 06/13/24), Identification and Emergency Information LIC 601 (dated: 06/17/24), Personal Rights of Resident LIC613-C (dated: 06/17/24), Resident Service Plan (dated: 07/13/24), Facility Visitor Log (dated: 08/01/24 -10/13/24), and Resident Authorization Form-POA (dated: 06/17/24).

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20241028134758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 10/30/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not allow resident to have visitors.

The details of this complaint alleged facility staff did not allow resident #1 (R1) to have visitors. It is reported that (R1) was refused a visit on 09/26/24, and the act violated (R1’s) personal rights.

On 10/30/24, between 1:00 pm – 1:40 pm, the Department interviewed residents #1-#4 (R1-R4) and found that they could not corroborate this accusation. (R1) stated has only been a resident at this facility since 06/19/24 have received visits from family and business representatives with no issues. (R1-R4) reported that no individuals have been denied visitations, and they are provided privacy during visits by the facility staff. (R1-R4) were complimentary of staff and claimed they were efficient and accommodating to their needs.

On 10/30/24, between 2:00 pm – 2:30 pm, the Department interviewed witnesses #1-#4 (W1-W4) and expressed they have had no problems with visits with the residents at this facility. (W1-W4) claimed they have never been restricted from visits and that staff have been accommodating with family guests to conduct visits outside of normal visiting hours.

On 10/30/24, between 11:15 pm – 12:40 pm, the Department interviewed staff #1-#5 (S1-S5) reported this allegation was false. (S1-S5) stated there are no guests who are denied visits unless there is a legal court order. (S1-S5) stated that guests' visits and communications are welcome 24/7. (S1-S2) who was mentioned in this complaint explained that on 09/26/24, a family guests from out of state visited (R1). A Notary Public accompanied the family associates. Parties met outside of the facility accordingly to (S2). The notary endorser had no idea that the family guests of (R1) were not the actual Power of Attorney (POA) to (R1). (S2) did not want to allow for the notary endorser to have access to (R1) until (R1’s) power of attorney (W1) was notified and authorized. (S1-S3) were able to verify this incident on 09/26/24 and stated that family guests from out of state have come to visit in the past and were allowed visits. (S1) stated no one of (R1’s) family guests or business representatives had been denied visitations with (R1). (S1-S2 and S5) indicated there have been some conflicts between (R1’s) family representatives of legal authority who should act on behalf of (R1). (S1 and S5) stated they were only protecting the interest of (R1) who had no knowledge of the Notary visit and had no authorization from (R1's) POA. (S2 and S5) stated the family guests from out of state came back a few hours later and met with the Executive Director (S5) in the lobby and did not sign the visitors log and did not want to see (R1) on 09/26/24 on the returned visit.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20241028134758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 10/30/2024

NARRATIVE

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As a result of the Department reviewing (R1’s) Admissions Agreement and Contract (dated: 06/17/24), revealed page 20, Section F included (Guest Visits and Communication), Resident Handbook (dated: 06/17/24), Physicians Report LIC 602A (dated: 06/13/24), Preplacement Appraisal Information LIC 603A (date: 06/13/24), Identification and Emergency Information LIC 601 (dated: 06/17/24) Personal Rights of Resident LIC613-C (dated: 06/17/24), Resident Service Plan (dated: 07/13/24), Facility Visitor Log (dated: 08/01/24 -10/13/24), and Resident Authorization Form-POA (dated: 0617/14) verified (W1) is the (POA) has the authority to act on behalf of (R1), and that (R1) had confirmation of visits from guests and business representatives according to Facility’s Visitors Log. Based on the gathered information, there is no evidence to support the allegation mentioned above.

Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview is conducted with Terri Weitzman, and a copy of the report is provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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