198320184-1-10-2024-11-AS-MVAO-D3ARSM-20240312131654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 01/10/2024
Date Signed: 01/10/2024 11:19:22 AM

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
06/24/2022 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220624095631

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: 45	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Joki Kanowitz, Executive Director		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Facility is not kept clean, safe and sanitary
Facility is not serving food of good quality
Facility did not ensure medication was dispensed correctly
Facility is not following COVID protocol

INVESTIGATION FINDINGS:

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On 1/10/24, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent complaint visit to deliver the complaint investigation findings at this facility. Upon arrival, LPA met with Jodi Kanowitz, Executive Director, who assisted with the visit. LPA explained the purpose of today's visit.

The investigation consisted of the following: On 6/28/22, LPA toured the inside and outside grounds of the facility with Director of Health Services, Jamie Pyles. LPA requested and obtained copies of Staff Roster, Resident Roster, Food Menu, Covid-19 Screening Records (April 2022-June 2022), and Medical Administration Records. LPA interviewed four out of twenty residents and five out of ten staff. On 9/22/2022, LPA attempted to interview a witness, but LPA was unsuccessful in contacting the potential witness. The alleged victim was no longer residing at the facility and LPA did not observe the resident during the visit.

Investigations revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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-20220624095631

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: 01/10/2024

NARRATIVE

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Allegation: Facility is not kept clean, safe and sanitary.

It is alleged that facility is not kept clean, safe and sanitary. On 6/28/2022, LPA Lourdes Montoya toured the inside and outside grounds of the facility. During the tour, LPA randomly checked resident bedrooms and bathrooms and did not observe feces on walls and floors. LPA did not observe stains on floors in hallways. Based on record review, there have been no incident reports or prior complaints indicating that facility was not kept clean, safe and sanitary. Based on interviews conducted, four out four residents (R2-R5) and five out of five staff (S1-S5) denied that facility is not kept clean, safe and sanitary. Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Facility is not serving food of good quality.

It is alleged that facility is not serving food of good quality. On 6/28/2022, LPA Lourdes Montoya toured the inside and outside grounds of the facility. During the tour, LPA checked the kitchen, dining area and the facility’s food supply. LPA observed residents eating in the dining area and LPA did not observe food being served is not of good quality. Based on record review, the facility maintains a daily food menu and residents have an option to choose their meal. Based on interviews conducted, four out four residents (R2-R5) and five out of five staff (S1-S5) denied that facility is not serving food of good quality. Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Facility did not ensure medication was dispensed correctly.

It is alleged that facility did not ensure medication was dispensed correctly. On 6/28/2022, LPA Lourdes Montoya toured the inside and outside grounds of the facility. During the tour, LPA checked the medication room. LPA observed the facility maintains residents’ medication administration records in electronic MAR called MedPass Machine. LPA reviewed random printouts of four residents’ MedPass records and LPA did not observe that facility staff dispensed wrong medications to residents.
Con'd on 9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220624095631

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: 01/10/2024

NARRATIVE

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Based on interviews conducted, four out four residents (R2-R5) and five out of five staff (S1-S5) denied that facility did not ensure medication was dispensed correctly. Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Facility is not following COVID protocol.

It is alleged that facility is not following COVID protocol. On 6/28/2022, LPA Lourdes Montoya toured the inside and outside grounds of the facility. During the tour, LPA checked reception desk, the hallways, resident bedrooms, and other common areas. LPA observed the receptionist screens every person entering the facility with a Face Recognition Body Measurement System Temperature Detection Scanner and Covid-19 health screening questionnaire. LPA Montoya was screened prior to entering the facility. LPA observed hand sanitizers at the reception area, masks are available, Infection Control guidelines for the prevention and spread of Covid-19 are posted. LPA observed each staff was wearing a face covering. Based on records review, the facility does not have any positive Covid-19 cases during the visit. LPA did not observe any residents in quarantine. Based on interviews conducted, four out four residents (R2-R5) and five out of five staff (S1-S5) denied that facility is not following COVID protocol. Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted, and a copy of the LIC 9099 report was provided to Executive Director, Jodi Kanowitz.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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