198320184-4-9-2025-11-AS-SCIS-DK2N8B-20250729101401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 04/09/2025
Date Signed: 04/09/2025 02:08:59 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: 53	DATE:	04/09/2025
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Terry Weitzman, Interim Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident sustained multiple fractures while in care due to lack of care from staff

INVESTIGATION FINDINGS:

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On 4/9/25, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent complaint visit to deliver 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: LPA requested and obtained copies of Staff Roster, 1/9/25, Resident Roster, dated 1/2/25, Service Plan, Resident ADL’s Sheets, (1/2024 – 8/2024), Staff Communications, (11/2023 – 2/2024), Admission Agreement, signed 8/30/23, Identification and Emergency Information dated 8/30/23 Physicians Report dated 9/7/23. LPA interviewed Staff 1 thru Staff 5 (S1 - S5) and Resident 2 thru Resident 5 (R2 - R5). On 11/13/24 and 4/9/25 LPA attempted to interview the R1, but LPA learned that R1 was no longer residing at the facility and had moved out 9/12/24 and no information has been received on where they relocated to.

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

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-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: 04/09/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Resident sustained multiple fractures while in care due to lack of care from staff

On 11/13/25, LPA reviewed facility file. Review of resident’s Physician Report dated, 9/7/23 indicated that resident R1 was ambulatory. The department reviewed 7 special incident reports that were submitted to Community Care Licensing Division, (CCLD), in which R1 fell 3 times, 12/1/23, 12/6/23 and 8/25/24. Per review of the Service Plan, staff were taking fall risk precautions by providing the resident with a lowered hospital bed which was at its lowest level while resident is in bed. Per nightshift notes, undated, staff provided hourly checks on R1. Upon review of unusual incident report, on 12/1/23 R1 stated that he had fallen during the night and staff sent resident to Kaiser ER. A review of medical records from Kaiser Permanente, dated 12/1/23 indicate that R1 had a Humerus (upper arm bone) fracture from an accidental fall. According to medical records reviewed, there was only one ER visit that a fracture was sustained.

LPA interviewed S1 – S5 and 5 out of 5 denied the allegation. LPA interviewed R2 – R5 and 4 out of 4 denied the allegation.

The Department found there is no evidence to corroborate the allegation mentioned above. The information and evidence obtained did not support the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation, “Resident sustained multiple fractures while in care due to lack of care from staff.” 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, as a result, the allegation is Unsubstantiated.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025

LIC9099 (FAS) - (06/04)

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