198320184-2-10-2023-11-AS-JHAD-CPFVVV-20230227154657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:30:57 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
02/03/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230203150359

FACILITY NAME:	AVENIR MEMORY CARE WESTSIDE		FACILITY NUMBER:	198320184
ADMINISTRATOR:	DRINKHOUSE-QUINTA, MARISSA		FACILITY TYPE:	740
ADDRESS:	7501 OSAGE AVE		TELEPHONE:	(424) 282-0040
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	88	CENSUS: 28	DATE:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Jacquline Vu & Judy Arreaga		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Facility staff are not adequately trained.

INVESTIGATION FINDINGS:

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On 02/10/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint investigation for the allegation listed above. LPA was greeted by Jacqueline Vu Business Office Manager. LPA explained the purpose of today's visit is to review and audit personnel records and conduct staff interview.

The investigation consisted of record reviews. A review of the following documents: Resident roster, Staff roster, analysis of personnel records for all (32) staff. Interview with staff #18 (S18). A tour of the facility was conducted.

Evaluation Report continue on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20230203150359

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 02/10/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff are not adequately trained.

The details of the complaint alleged several staff members have not completed training requirements. The complainant reported that management allows them to work on duty. The complainant also alleged staff #18 (S18) had a family member complete the training courses due to her lack of knowledge of the English language.

The Department conducted a review of all (32) employee personnel files. The record review consisted of auditing management, office, kitchen, and care staff. The investigation revealed, the facility hired training providers Relias Healthcare Training and Performance Solutions. The training is completed online and verification of training is provided for the employer a transcript of completed courses. As a result of the information gathered, the Department identified eight (8) direct care staff who did not complete the required training requirements by Title 22 Regulations 87707 Training Requirements If Advertising Dementia Special Care, Programming and/or Environments. The following staff was identified, (S1), (S5), (S6), (S7), (S9), (S10), (S13), and (S16) with incomplete required training courses.

The Department interviewed staff #18 (S18) who was named in this complaint for inappropriate conduct and denied the accusation. (S18) claimed to have completed all 27.60 hours of Relias training on her own without family assistance.

Based on the Department's observation and interviews, records and analysis reviewed, the preponderance of evidence standard has been met, therefore the allegation of "Facility staff are not adequately trained." is found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

An exit interview was conducted with Judy Arreaga and reports are provided along with appeal rights.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230203150359

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/24/2023 Section Cited CCR 87707(2)(A)(1-6)	1 2 3 4 5 6 7	87707 Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments (2) Direct care staff shall complete at least eight hours of in-service training... (A) A minimum..1.Effects of medications on the behavior of residents with dementia;2. Common problems, such as wandering, aggression, and inappropriate sexual behavior;3.Positive therapeutic interventions and activities such as exercise, sensory stimulation, activities of daily living, and social, recreational and rehabilitative activities.4. Communication skills (resident/staff relations); 5.Promoting resident dignity, independence, individuality, privacy and choice; and 6. End of life issues, including hospice.	1 2 3 4 5 6 7	Licensee will review Title 22 Sec. 87707 and agreed to provide training to staff pertaining to CCLD requirement for dementia care. Licensee will provide to LPA a proof of completion of courses from Relias. by POC date of 02/24/23.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on record reviews and interviews, the licensee did not comply with the section cited above. The care staff are not adequately trained. This violation poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Citations that are not cleared will incur civil penalties. There will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until POCs are cleared.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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