198320184-1-27-2025-11-AS-JHAD-DDRN97-20250210091528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 01/27/2025
Date Signed: 01/27/2025 08:31:28 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
01/06/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250106160350

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:	01/27/2025
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Terri Weitzman & Judy Kamenwa		TIME COMPLETED:	03:37 PM

ALLEGATION(S):

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Staff not providing safe environment for residents.

INVESTIGATION FINDINGS:

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On January 27, 2025, an associate from the California Department of Social Services/Community Care Licensing (CDSS/CCL) conducted a subsequent, unannounced complaint visit. The Executive Director, Terri Weitzman, and Director of Health and Services, Judy Kamenwa, greeted the associate. The associate explained that the purpose of this visit was to investigate the allegation mentioned above.

The investigation included a tour of the facility, interviews, and the collection of records. Interviews conducted with staff members #1 to #4 (S1-S4) and residents #1 to #5 (R1-R5). The associate reviewed several documents, including the Personnel Report LIC 500 (dated 01/09/25 & 01/26/25), the Register of Facility Residents LIC 9020 (dated 01/09/25 & 01/20/25), Resident #1 (R1)'s Physicians Report (dated 05/02/24), Admissions Orders (dated 05/02/24), Centrally Stored Medications (dated 12/17/24), Staff Communication Notes (dated 12/16/24-12/19/24) and other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

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-20250106160350

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: 01/27/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff not providing safe environment for residents.

The complaint alleges that the facility does not provide a safe environment for residents in its care. Resident #1 (R1) is reported to be a danger to oneself and to other residents, frequently displaying threatening behaviors such as yelling, screaming, slamming doors, and damaging property. These behaviors are causing fear among other residents, and no immediate intervention is reported from those who are aware of these incidents. No further details regarding this issue were provided.

On January 14, 2025, between 12:30 PM and 2:30 PM, the Department interviewed two staff members, Staff #1 and Staff #2, regarding the allegation, which they claim is untrue. Staff #1 and Staff #2 stated that Resident #1 (R1) was admitted on May 7, 2024, and has a diagnosis of late-onset neurocognitive disorder (NCD). They explained that (R1) did not require individual one-on-one care and only needed full assistance with medication management. (R1’s) Service Care Plan, (dated May 7, 2024), indicated that no additional support or help was required for (R1's) behaviors. The plan stated that the care team would monitor for any changes in condition and conduct a reappraisal as necessary. Staff #1 and Staff #2 claimed that (R1) was reappraised on December 1, 2024, when a new service plan was established. This plan indicated that (R1) required occasional intervention to de-escalate situations, with monitoring conducted as needed.

On November 20, 2024, (R1) was admitted to urgent care at UCLA Health in Santa Monica to be evaluated for a urinary tract infection (UTI). Staff #1 and Staff #2 observed a sudden change in (R1’s) behavior and notified the family representative, who admitted (R1) for observation. The medical evaluation revealed that (R1) did not have a UTI, and prescription medications were modified and returned to the facility.

On December 16, 2024, (R1) was taken to St. Joseph Providence Health Center for a psychological evaluation and returned the same day. Staff #2 noted that upon (R1's) return from the hospital, (R1) was being monitored hourly by the care team. Staff #1 and Staff #2 claimed that (R1's) aggressive behaviors do not harm oneself or others. They reported that (R1's) behaviors had decreased since the medication adjustment and that the care team provides daily monitoring. Staff #1 and Staff #2 explained that (R1's) behaviors, such as aggression, agitation, verbal abuse, mood swings, and restlessness, are common among residents with (NCD) and can stem from feeling overwhelmed or unable to cope.
(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250106160350

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: 01/27/2025

NARRATIVE

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On January 27, 2025, between 9:45 AM and 10:15 AM, the Department interviewed two additional staff members, Staff #3 and Staff #4, regarding the allegation, which they also claimed is false. Staff #3 and Staff #4 confirmed that they are aware of (R1's) behaviors and stated that the care team addresses any issues immediately. They reported that (R1) receives constant daily supervision, requiring mostly emotional support or redirection. Staff #3 and Staff #4 validated that (R1) has not harmed oneself or others. They noted that (R1's) aggressive behaviors have subsided since the reduction of medications. Staff #2 and Staff #3 confirmed that there is no shortage of care team staff to monitor residents' daily activities, with an average of five to six care staff members working each shift and medication technicians cross-trained as necessary. They asserted that the staff is proactive in supervision and professionally trained to handle residents with NCD. The facility is equipped with surveillance cameras in common areas to monitor activities, and staff charting notes are routinely implemented for communication.

On January 27, 2025, between 10:15 AM and 11:20 AM, the Department conducted interviews with (5) out of (5) residents, identified as R#1 through R#5. None of the residents were able to verify the allegation made against the facility. Residents R#2 to R#5 reported that the care team staff provided adequate care and supervision services. Furthermore, they expressed no concerns regarding their safety while living at the facility, stating that they felt the facility provided a safe and healthy environment for all residents. Resident R#1 was also interviewed but was unable to respond or engage in a full conversation due to (R1's) mental health condition.

On January 27, 2025, between 11:30 AM and 12:10 PM, the Department interviewed (3) out of (3) witnesses, identified as W#1 through W#3. None of the witnesses were able to verify the accusation made. Witnesses W#1 to W#3 claimed they had no concerns about the health or safety of the residents in care and were complimentary about the care and supervision provided by the facility staff.

The Department reviewed various documents related to Resident R#1, including their Physician's Report (LIC 602A dated 05/01/24), Service Plans (dated 05/07/24 and 12/01/24), Admissions Orders (dated 05/02/24), UCLA Health medical records (dated 11/20/24), St. Joseph Providence Health Center medical records (dated 12/16/24), Progress Notes (dated 05/08/24 – 01/08/25), and Staff Communication Notes (dated 12/16/24 – 12/17/24).

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250106160350

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: 01/27/2025

NARRATIVE

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This review revealed that Resident #1 could self-care and did not require one-on-one care. Furthermore, (R1's) mental condition did not stem from self-abuse or abuse towards others. A review of R#1's Physician's Medication Orders (dated 01/14/25) indicated that (R1) is prescribed ten medications, including five that had potential side effects of aggression, depression, confusion, and anxiety, according to the National Institutes of Health (NIH).

During a facility tour, it was noted that surveillance cameras were installed throughout the common areas to monitor activities. Based on all gathered information, there was insufficient evidence to support the stated allegation.

In conclusion, after reviewing the facility inspection, observations, interviews, and records analysis, the Department found no evidence to substantiate the allegation. While the allegation may have some merit or validity, there is not enough evidence to determine whether the alleged violation occurred. Therefore, the allegation is deemed unsubstantiated.

An exit interview was conducted with Judy Kamenwa, and copies of the reports were provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

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