198320184-12-29-2025-11-AS-SCIS-DQ9RP4-20260112121117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 12/29/2025
Date Signed: 12/29/2025 01:54:49 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: 56	DATE:	12/29/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ashley Shire-Executive director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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

INVESTIGATION FINDINGS:

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*This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 5/14/2025.* On 12/29/2025, At 1:38 PM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver the amended clairification report.

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 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), and Witness1(W1). LPA obtained and reviewed Resident 1(R1) admission agreement dated 1/7/2022 and signed on 12/18/2024 & 12/19/2024, physician’s report dated 6/24/2024 and 6/18/2025. The updated needs and service plan dated 6/16/2025. The resident move-in date has been confirmed as 12/21/2024 by Jodi Kanowitz, Executive Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

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 3

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: 12/29/2025

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 incontinence 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, did not confirm or deny any falls and was unable to have a clear conversation. LPA also interviewed R2 and R3 who stated they have not had any falls and there are 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 after each occurrence.

Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

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: 12/29/2025

NARRATIVE

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Further review of R1’s file revealed three incidents in which R1 sustained falls. On 2/25/2025 R1 was found on the floor in their room around 12AM, R1 was observed to have a scrape on their forehead 911 was called and transported to the Emergency Room for further observations and readmitted to the facility. On 03/28/2025 R1 sustained an unwitnessed fall in the bathroom reporting they felt dizzy falling, hitting their right elbow causing an abrasion. The resident was assessed and 911 was called and transported to the Emergency Room for further observation. On 5/5/2025 R1 had an unwitnessed fall in the common area and noted to have an abrasion on their head the resident was assessed and 911 was called and transported to the Emergency Room for further observations.

On 6/16/2025 R1 was reassessed by facility staff, and a fall risk plan was put in place. The plan, which indicates moderate assistance is needed, includes the following: one-person partial assist hand hold, assistance with observations & fall management, escorted to meals and activities, and use walker and wheelchair.

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. This report was signed by Ashley Shire.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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