198320184-7-31-2024-11-AS-UCOL-D8DRZC-20240822132745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 07/31/2024
Date Signed: 07/31/2024 05:07:06 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
07/29/2024 and conducted by Evaluator Socorro Leandro

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240729132131

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: 54	DATE:	07/31/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Executive Director - Jodi Kanowitz		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Possible elder abuse on the premises
Staff did not comply with infection control requirements
Staff used expired COVID tests to test residents
Facility is in disrepair

INVESTIGATION FINDINGS:

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On 07/31/2024 at around 10:40 AM Licensing Program Analyst (LPA) Socorro Leandro conducted a complaint investigation regarding the allegations listed above. LPA met with the Executive Director Jodi Kanowitz and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA and the Executive Director conducted a tour of the facility which included the front entrance lobby and medication rooms. LPA interviewed 5 out of 44 staff, 7 out of 54 residents, and 1 witness. LPA reviewed facility records and resident records, which included, Personnel Report, Resident Census, Personnel Records, Plan for Epidemic Outbreak Specific to Covid-19 Mitigation Plan Report, Invoices, etc.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

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-20240729132131

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: 07/31/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation “Possible elder abuse on the premises,” it is being alleged that staff have witnessed elder abuse in the facility. Interviews conducted revealed the following: 5 out of 5 staff indicated that they have not witnessed elder abuse in the facility. 6 out of 7 residents indicated that staff are nice to them. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff did not comply with infection control requirements,” it is being alleged that residents with a bad cold are not being isolated. Interviews conducted revealed the following: 5 out 5 staff indicated that facility isolates residents who have been tested positive for Covid-19, staff have been trained on infection control procedures, and they are and/or believe that the facility is following infection control requirements. 6 out of 7 residents believe that the facility is following infection control requirements. 1 witness states that the facility is isolating residents who have been tested positive with Covid-19. Observations revealed the following: There is one resident in isolation (due to health) and the facility following infection control requirements. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff used expired COVID tests to test residents,” it is being alleged that the facility is testing residents with expired Covid-19 tests. Observations revealed the following: There are non-expired Covid-19 test in the facility. The Executive Director and Director of Health Services indicated that they purchase Covid-19 test as needed to prevent test from going expired. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240729132131

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: 07/31/2024

NARRATIVE

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Regarding the allegation “Facility is in disrepair,” it is being alleged that the emergency exit door in the first floor next to the elevator cannot be opened manually. Observations revealed the following: The delay egress door on the first floor next to the elevator is in disrepair. The delay egress door was not opening after 30 seconds of pushing the door. Record review revealed the following: The facility received a quote on 07/05/2024 to fix the delay egress door. The facility is waiting on the mechanical parts to fix the door. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was left with the Executive Director.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

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