198320184-5-14-2025-11-AS-SCIS-DQ9RP6-20260112121117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 05/14/2025
Date Signed: 05/14/2025 01:29:57 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
05/08/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20250508145201

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:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Mario Singh- Director of Activities		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff do not provide adequate supervision resulting in resident sustaining multiple falls.

INVESTIGATION FINDINGS:

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On 05/14/2025 At 8:00 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to investigate and deliver the findings for the allegation listed above. Upon entry LPA was introduced to Mario Singh-Director of Activities who was also informed of the purpose of the visit.

The investigation consisted of interviews with staff members #1- #6 (S1-S6), attempted interview with Resident 1 (R1), R1's responsible party, R1 file review and observations.

Allegation: Staff do not provide adequate supervision resulting in resident sustaining multiple falls.

At approximately 8:20 AM, LPA Allen conducted interviews with six (6) staff members #1-#6 (S1-S6). All six stated they had not personally witnessed R1 fall but were aware of previous incidents that had been appropriately reported and documented according to protocol. Staff confirmed that R1 is consistently encouraged to remain in common areas where they can be observed and assisted with their needs.
continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20250508145201

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: 05/14/2025

NARRATIVE

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At approximately 10:25 AM, LPA attempted to interview R1; however, R1 was unable to remain on topic and did not confirm or deny any falls, leading to the conversation being discontinued.

At 11:20 AM, LPA Allen also interviewed R1's responsible party, who stated that the facility’s administrative staff had been in direct communication regarding R1's falls and expressed confidence that staff were doing their best to ensure R1's safety.

A review of R1’s file showed no documented designation of R1 as a fall risk or a need for a one-to-one ratio, though assistance with activities of daily living (ADLs) is required. Documentation of R1's incidents was also observed.

Additionally, during the visit, LPA Allen observed staff members actively providing care, engaging with residents, and redirecting individuals as needed. There was sufficient staffing at the time of the visit.

Based on interviews, file review and observation during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and provided to Judy Kamenwa at conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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