198320184-5-5-2023-11-AS-MVAO-CRWSZJ-20230517141914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 05/05/2023
Date Signed: 05/05/2023 10:25:25 AM

Unsubstantiated

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
02/24/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230224151441

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: 34	DATE:	05/05/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Ashley Shire		TIME COMPLETED:	10:31 AM

ALLEGATION(S):

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Staff denied resident visitations.

INVESTIGATION FINDINGS:

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On 05/05/23 Licensing Program Analyst (LPA) Ernand Dabuet initiated a subsequent complaint investigation and met with Director of Sales and Marketing Ashley Shire (S3) to deliver findings on the allegation listed above.

The investigation consisted of the following: On 03/02/23 Licensing Program Manager (LPM) Ulysses Coronel and Analyst (LPA) Mario Leon conducted an initial unannounced complaint visit at this facility. A plant inspection was conducted. Interviews with five residents (R1-R5) and 3 staff (S1-S3) were conducted. Facility and resident records were requested and reviewed. On 03/06/2023 LPA Leon interviewed witness (W2).

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

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: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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-20230224151441

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: 05/05/2023

NARRATIVE

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Allegation: Staff denied resident visitations.

The investigation revealed the following: It is being alleged that facility staff are denying resident visitations. During interviews staffs (S1), (S2) and (S3) corroborated that the facility was complying with a court ordered temporary restraining order (TRO) issued against (R1’s) visitor (V1) on 02/14/2023. (S2) confirmed that (V1) became upset when they were informed of the TRO during their visit. Residents (R1), (R3) and (R5) were not able to provide responses during interviews. Residents (R2) and (R4) denied the allegation and claimed that they can have visitors. Witness (W2) denied being present with (V1) on 02/14/2023. Record reviews revealed that the Superior Court of California issued a (TRO) dated 01/31/2023 which restricted (V1) from contacting (R1) in person or by other means between 01/31/2023 to 02/23/2023.

Based on the record reviews and interviews conducted, the Department found no evidence to support the allegation mentioned in this complaint. 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 Unsubstantiated.

No deficiencies were cited during this visit. An exit interview was conducted with Ashley Shire, and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC9099 (FAS) - (06/04)

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