198320184-1-9-2026-11-AS-SCIS-DSSVSD-20260403164122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 01/06/2026
Date Signed: 01/09/2026 09:13:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20251229150336

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:	0	CENSUS: 55	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Ashley Shire		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Staff hit resident in care

INVESTIGATION FINDINGS:

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On January 06, 2026, LPA Pamela Bunker conducted an initial visit to gather information regarding the allegation mentioned above. LPA met with Executive Director Ashley Shire and explained the purpose of today's visit. LPA was granted entry to the facility.

The investigation consisted of the following: On January 06, 2026 at 9:45 a.m., LPA Bunker requested and reviewed the staff and resident's records and obtained copies of the following documents: Personnel Report (11/20/2025), Resident Roster (12/16/2025), Admission Agreement (08/23/2023), Identification and Emergency Information (07/11/2023), Physician's Report (08/16/2023), Medication Administration Records (MARs) (08/21/2023-present) Medical Assessment (08/21/2023), Consent Forms (08/20/2023), Functional Capability Assessment (09/18/2025), Preplacement Appraisal Information (08/20/2023), Appraisal, Needs and Service Plan (09/18/2025), Personal Rights (08/202023), Resident Property Personal Property and Valuables (08/20/2023), Telecomunications Device Notification (08/21/2023) Special Incident Report (12/16/2025). See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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-20251229150336

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 01/06/2026

NARRATIVE

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Continued LIC9099--C page 2.

LPA Bunker and Executive Director Ashley Shire toured the facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit.

Interviews were conducted with Staff Members #1 and #5 (S1-S5) as well as with Residents #1(R1).

Investigation Findings
Allegation: Staff hit a resident in care.
On December 10, 2025, at approximately 8:30 a.m., it was alleged that a staff member hit Resident 1 (R1) on the hand. According to S1, the staff member who reported the incident did not do so until December 15, 2025—five days later—and did not provide a reason for the delayed reporting.

On January 6, 2026, between 10:00 a.m. and 4:15 p.m., LPA Bunker interviewed staff members S1 through S5. Staff members S1, S2, and S3 stated they did not witness any staff hitting R1. S5 reported witnessing a staff member hit R1 on both hands and stated that another staff member was present during the incident. S3 reported conducting a full body check on R1 and observed no injuries, bruising, redness, or swelling to R1’s hands.

Two staff members (2 out of 5) confirmed they were on duty at the time and stated that R1 was not hit by staff. S1, S2, and S3 reiterated that they did not witness any staff member hitting R1. S1 also stated that the facility completed its own investigation and determined the allegation to be unsubstantiated. On December 16, 2025, the facility self-reported the incident to Community Care Licensing, the Ombudsman, and all other appropriate agencies in a timely manner.

5 out of 5 staff members interviewed stated that R1 did not require any medical treatment. Staff members S1 through S4 denied the allegation.

On January 6, 2026, at 12:50 p.m., the Department interviewed Resident 1 regarding the allegation. R1 stated that staff did not hit them on the hand and denied the allegation.
See continued LIC9099-C page 2.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20251229150336

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 01/06/2026

NARRATIVE

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Continued LIC9099-C page 3.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. 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, therefore the allegation is deemed unsubstantiated.

There were no deficiencies cited. LPA Bunker provided Executive Director Ashley Shire with copies of the LIC9099 and LIC9099-C Complaint Investigation Reports.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3