198320184-3-15-2024-11-AS-SCIS-D5BP5N-20240516110057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 03/13/2024
Date Signed: 03/15/2024 01:03:00 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, 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
03/04/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240304160823

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:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jodi Kanowitz		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff are interfering with the residents visitations

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Pamela Bunker and Elvira Gonzalez conducted an unannounced complaint visit on Wednesday, March 13, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is not cleared of COVID-19 infection. LPA Bunker met with Executive Director Jodi Kanowitz. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPAs Bunker and Gonzalez interviewed staff 1-3 (S1-S3) and residents 1-4 (R1-R4). LPAs asked questions relevant to the nature of the complaint. S1-S3 and R1-R4 stated the facility staff is not interfering with the resident's visitations. S1-S3 stated the facility had a COVID-19 outbreak from 02/26/2024 to 03/05/2024. The facility is following the Department of Public Health guidelines according to visitation procedures. S1-S3 stated the facility has been doing mass COVID-19 testing. If a staff or residents have positive results it is reported to all the appropriate agencies timely. LPA Bunker requested copies of supporting documents. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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 3

Control Number 11-AS-20240304160823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 03/13/2024

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Staff are interfering with the resident's visitations. S1-S3 and R1-R4 interviewed stated staff are not interfering with the resident's visitations. S1 stated residents are allowed visitors in the outside patio area, common area, and in front of the facility's building. S1-S3 stated staff is following COVID-19 procedures of the Department of Public Health. S1-S3 stated if there are positive COVID-19 results all team members, residents, families, responsible parties, visitors, and appropriate agencies are notified immediately via letter and email. LPA observed the facility has an approved Mitigation Plan Report and Infection Control Plan on file. S1 stated the facility is following the Mitigation and Infection Control Plan, emails and letters have been sent, and the residents are notified door to door with a memo letter, which is posted at the receptionist desk and throughout the facility if a resident or staff test results are positive for COVID-19 which made cause limitation to visitations during the COVID-19 outbreaks. S1 stated everyone is notified if there is a positive COVID-19 case. S1 stated if staff and residents had any questions staff is available to answer questions.

Investigation revealed the following: Interviews with staff members 1 to 3 (S1-S3) and residents 1 to 4 (R1-R4) have confirmed that the facility maintains open visitation policies, allowing residents to engage with their families both within and outside the premises. Specifically, residents are permitted to leave the facility for community visits, utilize the courtyard for outdoor gatherings, and, in cases where a resident is bed-bound, family visits are allowed in the resident's room, contingent upon a negative COVID-19 test result and proper usage of masks.

S1-S3 stated during the period from February 26, 2024, to March 5, 2024, the facility experienced a COVID-19 outbreak affecting 20 residents and 5 staff members. This outbreak, as reported by S1, was promptly communicated to the Department of Public Health, Community Care Licensing, responsible parties of the residents, and all relevant agencies, underscoring the facility's commitment to transparency and regulatory compliance.

Both staff and residents (S1-S3 and R1-R4) have unanimously reported that cohabitation of COVID-19 -positive and negative residents is strictly avoided to prevent cross-infection. Consistent usage of masks among staff and residents has been observed, including during LPA's visit. Positive cases are assigned to a dedicated Med Tech or nurse, ensuring focused care and monitoring. See continued LIC9099-C page 3

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240304160823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 03/13/2024

NARRATIVE

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Continued LIC812-C page 3

S1-S3 have elaborated on the medical protocols in place for both staff and residents, including the administration of medications, conducting of COVID-19 rapid tests, and the arrangement for Polymerase Chain Reaction (PCR) testing for both staff and residents through external laboratory services. Additionally, measures are in place for the safe delivery of meals to residents' rooms by caregivers, ensuring minimal contact and risk of virus transmission.

The facility also adheres to a rigorous testing protocol, with immediate notification of test results to all staff and residents. In situations where a resident may be absent during mass testing events, arrangements are made to test them upon their return, guaranteeing that all individuals within the facility are accounted for in the ongoing efforts to manage and mitigate the spread of COVID-19.

S1 stated the facility is adequately staffed and the facility staff is trained, qualified, and competent and their respective roles. and staff undergoes continuous training to ensure their skills and knowledge remain current and effective. LPA reviewed the facility’s surveillance testing records. S1 stated the facility is following the policies and procedures set forth by the Department of Public Health.

S1 also mentioned that a significant portion of the staff and the majority of the residents have completed their COVID-19 vaccinations. The facility has the ability to quarantine either non-symptomatic or positive COVID-19 residents. S1 stated the facility is following all guidance and direction regarding infection control protocol. S1 stated that whenever they receive a positive COVID-19 test result it is reported to all the appropriate agencies, Community Care Licensing, Los Angeles County Department of Public Health, resident's families, responsible parties, staff, residents, and visitors are notified immediately. Staff 1-3 (S1-S3) and residents 1-4 (R1-R4) interviewed all denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.
A copy of the Complaint Investigation Report LIC 9099 and LIC9099-Cs, was provided to staff.
There were no deficiencies cited. An exit interview was conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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