198320197-1-13-2023-11-AS-SCIS-CSTUXC-20230615155806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 01/11/2023
Date Signed: 01/13/2023 08:28:16 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
01/03/2023 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230103093649

FACILITY NAME:	PLAZA AT WESTWOOD, THE		FACILITY NUMBER:	198320197
ADMINISTRATOR:	KELLEY KOUL		FACILITY TYPE:	740
ADDRESS:	2228 WESTWOOD BLVD		TELEPHONE:	(323) 217-7877
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	136	CENSUS: 58	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Virginia Zenteno		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff are not wearing masks.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, January 11, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Virginia Zenteno. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-4 (S1-S4) and residents 1-6 (R1-R6). LPA Bunker asked questions relevant to the nature of the complaint. S1-S4 and R1-R6 stated staff does wear their masks as required. We observed signs posted throughout the facility requesting staff, residents, and visitors to please wear their masks. LPA Bunker requested copies of supporting documents.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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-20230103093649

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: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 01/11/2023

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Facility staff are not wearing masks. Staff 1-4 (S1-S4) and residents 1-6 (R1-R6) interviewed stated staff is following the mandatory masks procedures. LPA observed the facility has an approved Mitigation Plan Report and Infection Control Plan on file. ED Ms. Zenteno stated staff are following the mandated mask policy. ED Ms. Zenbteno stated masks are required for all staff, residents, and visitors in common areas at all time. If staff, residents, or visitors had any questions staff is available to answer questions.

Investigation revealed the following: Interviews were conducted with staff 1-4 (S1-S4), and residents 1-6 (R1-R6). S1-S4 and R1-R6 stated staff, residents, and visitors are wearing their masks when they are at the facility it's for everyone's health and safety. LPA Bunker observed staff, residents, and visitors with their masks on during today's visit. S1-S4 and R1-R6 stated staff always wear their mask and they have never observed the Activity Director without a mask. S1-4 and R1-R6 stated staff encourage all residents to wear their masks, sometimes a residents may forget to put on their masks and staff will remind residents to put on their masks. S1-S4 and R1-R6 stated residents remove their masks to eat and them put it back on when they are done eating. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Plan. ED Ms. Zenteno stated the facility is reading all Community Care Licensing Division (CCLD) PINS, following all guidelines and direction regarding Mitigation Plan and Infection Control Protocol regarding facial masks. ED Ms. Zenteno stated resident's families, responsible parties, staff, residents, and visitors wear masks. S1-S4 and R1-R6 stated the allegations are false. Staff 1-4 (S1-S4) and residents 1-6 (R1-R6) interviewed all denied the allegations.

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

A copy of the Complaint Investigation Report LIC 9099 and LIC9099-C, was provided to Executive Director (ED) Virginia Zenteno.

There were no deficiencies cited. An exit interview was conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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