198320197-5-23-2022-11-AS-UCOL-CGQM9S-20220727092514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 05/23/2022
Date Signed: 05/23/2022 03:24:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/19/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220519094757

FACILITY NAME:	PLAZA AT WESTWOOD, THE		FACILITY NUMBER:	198320197
ADMINISTRATOR:	KOUL, KELLY		FACILITY TYPE:	740
ADDRESS:	2228 WESTWOOD BLVD		TELEPHONE:	(323) 217-7877
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	136	CENSUS: 56	DATE:	05/23/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kelley Koul		TIME COMPLETED:	02:57 PM

ALLEGATION(S):

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Resident was physically attacked by another resident on more than one occasion.

INVESTIGATION FINDINGS:

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On 05/23/2022 Licensing Program Analyst (LPA) Troy Agard conducted an initial complaint investigation at the above facility to address the following allegation. LPA Agard was met with Kelly Koul, Administrator and explained the purpose of the visit was to gather information regarding this complaint.

The investigation consisted of the following: On 05/23/2022, LPA conducted a walkthrough and requested copies of facility records. LPA requested: Staff and Client roster, incident reports from the past 90 days, needs and service plans for R1 & R2 and medication records.

On 05/23/2022, LPA Agard delivered findings.

Regarding the allegation: “Resident was physically attacked by another resident on more than one occasion.” It’s being alleged that a resident has been assaulted by another resident in care several times. Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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-20220519094757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 05/23/2022

NARRATIVE

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The investigation revealed the following: 3 of 3 staff generally state that residents are not attacking one another. S1 states, a recent incident occurred between two residents. “The alleged victim is R2, and the alleged perpetrator is R1. R2 doesn’t typically come down for meals, but just started, and would sit at the table with R1. We noticed that R1 is triggered by the fact that R2 will try to sit with them. We instructed R2 to please sit at another table. We are not clear about the actual trigger. We haven’t seen anything physical. R2 alleged that they were assaulted by R1 under the table. I don’t know If they were kicked due to it being under the table and not visible.” S2 generally states not witnessing anything physical. “I didn’t see anyone get hit. They were just talking. R2 never stated they got kicked.” S3 states there was an incident that occurred but did not witness anything firsthand.

During interviews with residents, the following was revealed: R1 generally denies any involvement with R2s’ assault. “I don’t recall kicking them, no.” R2 states they were assaulted by R1 on multiple occasions but never reported it. “We were friends and I didn’t want anything to happened to R1. We became friends about 4 months ago, so I started sitting at their table. It was my table first and I have been sitting there for 4 months or so. R1 started telling me all these “put downs and stuff.” I told them to stop it and if they were not happy, they could move. R1 started kicking me and stuff under the table and pinching me and trying to push me off my chair under the table. R1 would stomp on my foot and say mean things.” R3 denies witnessing R1 assaulting R2 but confirms witnessing verbal abuse. “I’ve never seen R1 attack R2, but I believe that they kicked them because R1 abuses R2 verbally.”

During a record review, LPA did not observe R2 on any blood thinning medications that may result in bruising. LPA did not observe R2 to have any bruising in the location they reported being kicked.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. 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.

An exit interview was conducted, and a copy of the report was given

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC9099 (FAS) - (06/04)

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