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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 02/26/2025
Date Signed: 03/10/2025 01:19:58 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
02/20/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250220090859
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: 53DATE:
02/26/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:DIRECTOR TERRI WEITZMANTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff does not ensure that facility is free of tripping hazards
INVESTIGATION FINDINGS:
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This report supersedes the report dated 02/26/2025. The investigation findings have not changed from Substantiated.

Community Care Licensing Division (CCLD) conducted an unannounced visit to Avenir Memory Care Westside facility on 02/26/2025 and met with Director Terri Weitzman (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

During this investigation, CCLD staff interviewed staff S1-S3 and interview residents R1- R5. CCLD staff obtained and reviewed the following records: Carpet replacement quote (dated 02/26/2025), email from facility owner (dated 02/11/2025 to 02/26/2025). Toured the facility with Manager Mario Singh (S2).

The investigation revealed the following:

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
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 3
Control Number 11-AS-20250220090859
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: 02/26/2025
NARRATIVE
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Regarding Allegation: Staff does not ensure that facility is free of tripping hazards.

This complaint alleged that staff did not replace damaged carpet on the second floor, which is a tripping hazard. During the investigation CCLD staff toured the facility and noted that the carpet on the second-floor common areas is ripped and in disrepair. CCLD staff noted the carpet was ripped in many areas on the second floor. CCLD staff also noted that the carpet was dirty and had not been cleaned in some time. Record review indicate the following: Reviewed the emails between the owner and the staff dated 02/11/2025 to 02/26/2025. The owner confirmed that the second-floor carpets need to be replaced. Reviewed quote from Empire Carpets dated 02/26/2025, cost to replace the damaged carpets will be $1306.79. Interviews indicated the following: 5 out of 5 residents indicated that they did not know that the carpet on the second floor is a tripping hazard to staff and resident. 5 out of 5 residents indicate that they have not tripped or fallen due to the carpet. 3 out of 3 staff indicate that the second-floor carpet is damaged and is a tripping hazard. 3 out of 3 staff indicate that the carpet on the second floor has been damaged for at least 3 months.

Based on records review observations and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “staff does not ensure that the facility is free of tripping hazards” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, and plan of correction were developed. A copy of the Complaint Report and appeals rights were provided to the Director Terri Weitzman S1.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20250220090859
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: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2025
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
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Licensee will esnure facility is in good reapir at all times. As plan of correction, licensee will replace the second floor carpets. Proof of correction will sent to LPA via email before POC due date.
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Based on [(observation), interviews and record review , the licensee did not comply with the section cited above in having the damaged carpet replaced which poses/posed a potential health, safety or personal rights risk to persons in care.
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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: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3