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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 01/02/2025
Date Signed: 01/02/2025 02:06:55 PM

Substantiated


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
09/03/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240903161404
FACILITY NAME:AVENIR MEMORY CARE WESTSIDEFACILITY NUMBER:
198320184
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:7501 OSAGE AVETELEPHONE:
(424) 282-0040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:88CENSUS: 48DATE:
01/02/2025
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:TERRI WEITZMAN, Interim Executive DirectorTIME COMPLETED:
02:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure adequate supervision is provided to residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/02/25 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted a subsequent complaint visit at the facility. LPA was met by Terri Weitzman, Interim Executive Director (S5) and the purpose of the visit was explained.

The investigation consisted of the following:
On 01/02/25 CCLD requested facility records, which included conversations between the facilities' managment and responsible party(ies) and Power of Attorney's (POA's) and requested video footage of the date listed in the details of the allegation, took a tour of the facility with S6 and interviewed two (2) staff. The video footage was not in-service from the dates of 05/06/24 through 11/19/24.
On 09/11/24 CCLD requested documents and toured the facility. LPA interviewed four (4) staff and four (4) residents, one (1) resident did not respond to CCLD staff's interview due to their medical condition. CCLD requested additonal video footage, but the footage was not currently available for LPA's review as the facility is without a Maintenance Director. Report continues, see LIC9099-C.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
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-20240903161404
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: 01/02/2025
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
The investigation revealed the following:
Regarding the allegation "Staff do not ensure adequate supervision is provided to residents in care", it has been alleged that resident(s) roam into other residents' room which resulted in an injury.

Interviews revealed that three (3) out of four (4) residents and three (3) out of six (6) staff have agreed the allegation has taken place. Record reviews have shown that on 01/02/25, S6 produced a reminder sheet for caregivers, noting: "When exiting a resident's room, even if the room is occupied. Please lock the door behind you. This will assure the safety of our residents. It will help secure that no one will intrude on their privacy." in both English and Spanish. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC9099-D.

One deficiency has been cited during today's visit.



An exit interview was held with Terri Weitzman (S6) and a copy of this report, this deficiency and appeal rights have been provided to Terri Weitzman (S6).
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240903161404
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
87411(d)(3)
1
2
3
4
5
6
7
87411 Personnel Requirements - General
(d) All personnel shall be given...job training... in the job assigned to them...
(3) Skill and knowledge required...necessary resident care and supervision, including the ability to communicate with residents.
This has not been met as evidenced by:
1
2
3
4
5
6
7
Facility interim executive director (S6) and CCLD staff have agreed that any on-duty staff will receive an in-service training to remind staff at how to redirect wandering residents and how to prevent incident(s) between staff on resident and resident on resident incident(s). S6 will email CCLD staff
8
9
10
11
12
13
14
CCLD staff's interviews confirmed that there was, and currently is, a resident who has been observed to enter other residents' units.
8
9
10
11
12
13
14
, via MARIO.LEON@DSS.CA.GOV, the sign-in sheet(s) and short summary of topic(s) covered during the staff training on or before POC due date which is 01/17/24.
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.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/03/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240903161404

FACILITY NAME:AVENIR MEMORY CARE WESTSIDEFACILITY NUMBER:
198320184
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:7501 OSAGE AVETELEPHONE:
(424) 282-0040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:88CENSUS: 48DATE:
01/02/2025
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:TERRI WEITZMAN, Interim Executive DirectorTIME COMPLETED:
02:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure adequate supervision is provided to residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/02/25 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted a subsequent complaint visit at the facility. LPA was met by Terri Weitzman, Interim Executive Director (S5) and the purpose of the visit was explained.

The investigation consisted of the following:
On 01/02/25 CCLD requested facility records, which included text messages and email conversations between the facilities' managment and responsible party(ies) and Power of Attorney's (POA's) and reviewed special incident reports (SIR) on file. CCLD also requested video footage of the date listed in the details of the allegation, took a tour of the facility with S6 and interviewed two additional (2) staff. The video footage was not in-service from the dates of 05/06/24 through 11/19/24. On 09/11/2024 LPA requested documents and toured the facility. LPA interviewed four (4) staff and four (4) residents. LPA requested additonal video footage, but the footage is not currently avaialble for LPA's review as the facility is without a Maintenance Director. Report continues, see LIC9099-C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240903161404
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: 01/02/2025
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
Regarding the allegation "Staff do not ensure adequate supervision is provided to residents in care", it has been alleged that residents do not have enough supervision in order to prevent incidents between residents occurring.

Interviews revealed that two (2) out of three (3) residents and four (4) out of six (6) staff have indicated that resident(s) have roamed into other residents’ rooms in the past and that instances or circumstances have occurred during the dates in question. Record reviews have shown communications between the facility staff and responsible parties of ten (10) residents from the dates of May, 2024 - Jan, 2025, including one (1) SIR of which involves an altercation between two (2) residents. This SIR received aligns with what CCLD has been provided from the facility. Neither resident has been indicated in the details of the allegation. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

An exit interview was held with Terri Weitzman (S6) and a copy of this report has been provided to Terri Weitzman (S6).
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5