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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 07/16/2025
Date Signed: 07/16/2025 05:05:25 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 WESTSIDEFACILITY NUMBER:
198320184
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:7501 OSAGE AVETELEPHONE:
(424) 282-0040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:88CENSUS: 57DATE:
07/16/2025
UNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Jodi Kanowitz-Administrator TIME COMPLETED:
05:18 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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***This report supersedes the original report delivered on 5/14/2025. On 7/16/2025, the LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 5/14/2025. ***

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 the following:

Interviews with Staff members 1- 6 (S1-S6), Resident 1- 5 (R1-R5), Witness1(W1) R1s file was reviewed which consisted of physicians report dated 6/7/2024, admission orders dated 12/15/2024,LIC624 reports dated 2/25/2025,3/28/2025, and 5/6/2025, Emergency Information and contact, needs and service plan dated 6/16/2025, client roster dated 5/7/2025, Personnel report dated 5/7/2025 and observations.
Continued .....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
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 2
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: 07/16/2025
NARRATIVE
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The investigation revealed the following:

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

At approximately 8:20 AM, LPA Allen conducted interviews with six (6) staff members 1-6 (S1-S6). 6 out of 6 staff stated they had not personally witnessed R1 fall but were aware of previous incidents that have been reported and documented. Staff stated R1 needs and service plans are always followed however because moderate assistance is required staff does allow R1 privacy while helping with incontinent needs. Staff also stated R1 is consistently encouraged to remain in common areas where they can be assisted with their mobility/transfer needs and observations.

At approximately 10:25 AM, LPA interviewed five (5) Residents. LPA attempted to interview R1; however, R1 was unable to remain on topic and did not confirm or deny any falls and unable to have a clear conversation. LPA also interviewed R2 and R3 who stated they have not had any falls and there is staff there to help them. LPA attempted to interview R4 and R5, but they were unable to have a clear conversation.

At 11:20 AM, LPA Allen interviewed an external witness (W1), who reported that R1 has fallen or slid from their wheelchair on three occasions. W1 mentioned that the facility’s administrative staff had been in direct communication regarding R1's falls and expressed confidence that the staff were doing their best to ensure R1's safety. LPA Allen also reviewed the 2024 and 2025 physician reports, which indicates that stand-by to moderate assistance is required. Additionally, LPA Allen observed that there is a care plan in place for transfer and mobility, which specifies assistance with resident participation.

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 some assistance with activities of daily living (ADLs) is required. Documentation of R1's incidents also obtained and reviewed which shows staff did report the incidents for each occurrence.

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 Jodi Kanowitz Administrator at the conclusion of the visit with appeal rights.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2