198320184-1-16-2025-11-AS-SCIS-DK2N8C-20250729101402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 01/16/2025
Date Signed: 01/16/2025 02:07:20 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
08/27/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240827213603

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:	DATE:	01/16/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Terry Weitzman, Interim		TIME COMPLETED:	02:07 PM

ALLEGATION(S):

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Staff did not ensure that resident was adequately fed
Staff did not meet resident's toileting needs
Staff mismanaged resident's medication

INVESTIGATION FINDINGS:

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On 1/16/25, 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 Interim Executive Director, Terry Weitzman who assisted with the visit. LPA explained the purpose of today's visit and was granted entrance to facility grounds.

The investigation consisted of the following: On 8/29/24 and 11/13/24, LPA toured the inside and outside grounds of the facility for a health and safety inspection. LPA requested and obtained copies of Staff Roster, Resident Roster, Resident ADL’s Sheet, Staff Communications, Admission Agreement, Resident Handbook, Hospitalization and visits log, Identification and Emergency Information, Physicians Report, Preplacement Appraisal, Medication List, Dietary Communication and Advance Health Care Directives. LPA interviewed Staff 1 thru Staff 5 (S1 - S5) and Resident 2 thru Resident 5 (R2 - R5). On 11/13/24, LPA attempted to interview the R1, but LPA learned that R-1 was no longer residing at the facility and had moved out 9/12/24.
Investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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 4

Control Number 11-AS-20240827213603

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: 01/16/2025

NARRATIVE

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Allegation: Staff did not ensure that resident was adequately fed

It is alleged that resident was not eating and as a result R-1 had lost a lot of weight Per staff interviews and a review of the Admission Agreement LPA Felisa Shirley observed that there are three meals and three snacks served daily which are included in their monthly fee. Per interview with S-2, caregivers will assist if they notice that resident is not eating and will offer alternatives if desired. LPA Shirley toured the inside and outside grounds of the facility. LPA Shirley observed residents eating in the dining area and LPA Shirley did not observe food being served is not of good quality. LPA Shirley reviewed residents service file and Physician’s Report and observed that R-2 had a regular diet. Per Preplacement Appraisal Information, R-1 feeds self independently. LPA Shirley observed R-1’s Narrative charting and observed that R-1 sometimes ate only 50% of his meal and sometimes refused to eat because he didn’t want to gain weight. LPA Shirley reviewed R-1’s weight chart and did not observe a drastic weight loss.

LPA Shirley interviewed staff-1 thru staff-5 (S-1 thru S-5). LPA asked, does staff monitor residents during meals ensuring that residents are adequately fed. Of those interviewed, 5 out of 5 staff answered yes. LPA interviewed Resident-1 thru Resident-7 (R-1 thru R-7). LPA asked, do you get enough food and are you allowed seconds if desired? Of those interviewed, 4 out of 4 answered yes. R-1 was not available.

Allegation: Staff did not meet resident’s toileting needs

It is alleged that staff were not changing resident as needed. LPA Shirley reviewed R-1’s Resident Daily Activities of Daily Living Sheet and log of incontinence care for the AM and PM shifts from January 2024 thru August 2024. LPA observed that there were entries on log sheet for incontinence changing on a consistent basis.

LPA Shirley interviewed staff-1 thru staff-5 (S-1 thru S-5). LPA asked, is there a schedule for incontinence needs and if resident’s needs were being met. Of those interviewed, 5 out of 5 staff answered yes. LPA interviewed Resident-2 thru Resident-5 (R-2 thru R-5). LPA asked, are your incontinence needs being met? Of those interviewed, 2 out of 4 answered yes, and 2 stated that they were good on their own. R-1 was not available.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240827213603

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: 01/16/2025

NARRATIVE

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Allegation: Staff mismanaged resident’s medication

It is alleged that resident was being overmedicated. During the tour, LPA checked the medication room. LPA observed the facility maintains residents’ medication administration records in electronic QuickMAR. LPA observed that staff discontinued medications as instructed by treating physicians. LPA reviewed printouts of the resident’s eMar and LPA observed that staff made consistent entries and noted when R1 was not available and refused medications. LPA did not observe that facility staff dispensed wrong medications nor overmedicated prescribed medications to R-1.

LPA Shirley interviewed staff-1 thru staff-5 (S-1 thru S-5). LPA asked, is there a system in place that you have to ensure that resident’s medications aren’t being mismanaged. Of those interviewed, 3 out of 5 staff answered yes, and 2 staff did not know about dispensing medication. LPA interviewed Resident-2 thru Resident-5 (R-2 thru R-5). LPA asked, has your medications ever been mismanaged to your knowledge? Of those interviewed, 4 out of 4 answered did not believe that their medications were mismanaged. R-1 was not available.

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 Interim Executive Director, Terry Weitzman.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

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