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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 08/29/2025
Date Signed: 08/29/2025 01:10:46 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
08/19/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250819130955
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: 52DATE:
08/29/2025
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Judy Kamenwa/Director oh Health ServicesTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff did not address a resident's change in medical condition
Staff did not provide adequate care and supervision
Staff did not properly report incidents involving the residents
INVESTIGATION FINDINGS:
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On 8/29/2025 at approximately 8:10 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met Jodi Kanowitz/Executive Director then later with Judy Kamenwa/Director of Health Services. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director’s Interview (A#1), Witness Interviews(W#1), Residents Interviews (R#1-R#6) and Staff Interview (S#1-S#5). LPA obtained and reviewed the following documents: Resident Roster dated: 8/27/25, Staff Roster dated: 8/27/25, copy of (R#1)’s face sheet dated: 6/18 24, (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated:4/10/25,5/16/24, and 2/6/23, copy of (R#1)’s Physician Orders for Life-Sustaining Treatment (POLST) no date... SEE LIC 812.

Evaluation Report continues LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
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 6
Control Number 11-AS-20250819130955
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: 08/29/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff did not address a resident's change in medical condition

The details of the complaint alleged that facility staff did not address (R#1)’s change in condition.



On August 29, 2025, at approximately 8:00 a.m., during the records review, LPA Iniguez reviewed (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A, LPA Iniguez observed that the LIC 602A was done every year, the first one was done on 2/6/23, the second one was done on 5/16/24 and the most recent was done on 4/10/25. Performing LIC 602A every year indicates that the facility was following Title 22 regulations for residents with cognitive impairments and their changes in condition. Additionally, LPA Iniguez reviewed (R#1)’s hospice admission notes. On 7/12/24 (R#1) was enrolled in hospice services due to their health condition, then it was discharged since their health improved; however, (R#1) got enrolled in hospice services on 7/25/25 until their last days.

On August 28, 2025, at approximately 1:00 PM, during an Interview with the Executive Director (A#1), she stated that when (R#1) sustained a fall, the facility immediately informed their physician and addressed their health condition, signing them up for hospice services twice while they resided here.



On August 28, 2025, at approximately 1:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message. On August 28, 2025, at approximately 2:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message. On August 28, 2025, at approximately 3:30 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20250819130955
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: 08/29/2025
NARRATIVE
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On August 28, 2025, at approximately 2:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez was unable to speak with (R#1) since they had passed away on August 9, 2025.

On August 28, 2025, at approximately 2:00 PM, during an interview with residents (R#2-R#6), (5) out of (5) stated that they think the facility will alert their physicians and representatives in case their health condition changes.

On August 28, 2025, at approximately 1:00 PM, during an interview with facility staff (S#1-S#5), (5) out of (5) stated that when (R#1) sustained a fall, the facility contacted their physician. The physician will provide us with orders to address any changes in conditions that occur.

Allegation: Staff did not provide adequate care and supervision

The details of the complaint alleged that facility staff did not provide adequate care and supervision for (R#1).



On August 29, 2025, at approximately 9:00 a.m., during the records review, LPA Iniguez observed copies of (R#1)’s monthly facility logs for incontinence check and resident daily activities of daily living (ADL’s) check, LPA Iniguez observed that the facility conducted every day (ADLs) checks on (R#1) from 2023 until 2025. Additionally, the facility conducted nightly incontinence checks every other hour on (R#1) monthly from 2023 until 2025.

On August 28, 2025, at approximately 10:00 AM, during an Interview with the Executive Director (A#1), she stated that (R#1) always had enough care and supervision from facility staff.



Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20250819130955
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: 08/29/2025
NARRATIVE
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On August 28, 2025, at approximately 1:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call; LPA Iniguez left a voicemail. On August 28, 2025, at approximately 2:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message. On August 28, 2025, at approximately 3:30 PM, Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message.

On August 28, 2025, at approximately 2:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez was unable to speak with (R#1) since they had passed away on August 9, 2025.

On August 28, 2025, at approximately 2:00 PM, during an interview with residents (R#2-R#6), (5) out of (5) stated that the facility staff provides enough care and supervision for them.

On August 28, 2025, at approximately 1:00 PM, during an interview with facility staff (S#1-S#5), (5) out of (5) stated that (R#1) had enough care and supervision while residing at the facility.

Allegation: Staff did not properly report incidents involving the residents

The details of the complaint alleged that facility administrator told staff not to report (R#1)’s incidents.



On August 29, 2025, at approximately 9:00 a.m., during the records review, LPA Iniguez observed copies of (R#1) 's Unusual Incident Reports or LIC 624. LPA Iniguez observed that the facility recorded and reported every incident (R#1) to CCLD and the Long-Term Care Ombudsman via fax. Additionally, LPA Iniguez reviewed copies of the facility's Incident Report; these reports are closely tied to the LIC 624 forms.

Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20250819130955
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: 08/29/2025
NARRATIVE
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On August 28, 2025, at approximately 10:00 a.m., during an Interview with the Executive Director (A#1), she stated that the Director of Health Services oversees recording the resident's incidents; in this case, (R#1)'s incidents were reported to CCLD and their representative. Additionally, (A#1) stated that she has never instructed facility staff not to report (R#1)'s incidents; on the contrary, she has encouraged them to do so.

On August 28, 2025, at approximately 1:00 p.m., Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message. On August 28, 2025, at approximately 2:00 p.m., Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message. On August 28, 2025, at approximately 3:30 p.m., Licensing Program Analyst-LPA Alfonso Iniguez contacted (W#1) via telephone. (W#1) did not answer the call, and LPA Iniguez left a voice message.

On August 28, 2025, at approximately 2:00 p.m., Licensing Program Analyst-LPA Alfonso Iniguez was unable to speak with (R#1) since they had passed away on August 9, 2025.

On August 28, 2025, at approximately 2:00 p.m., during an interview with residents (R#2-R#6), (5) out of (5) stated that they feel the facility will report to their representatives and physician if something happens to them.

On August 28, 2025, at approximately 1:00 p.m., during an interview with facility staff (S#1-S#5), (5) out of (5) stated that (A#1) has not told them not to report (R#1) 's incidents; on the contrary, they must report everything.


Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20250819130955
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: 08/29/2025
NARRATIVE
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During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted, and a copy of the Complaint Report was given to Judy Kamenwa/Director of Health Services.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6