198320197-9-27-2023-11-AS-RORN-CWJMVX-20231012095728

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:04:15 PM

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
12/12/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221212175410

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: 62	DATE:	09/27/2023
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Luz E. Rose		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff does not keep resident's room clean.
Staff does not treat resident with dignity or respect.

INVESTIGATION FINDINGS:

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On 09/27/23, at 10:11am, Licensing Program Analyst (LPA) Perry Scott conducted a complaint visit to this facility to gather information about the above allegation(s). LPA met with Luz E. Rose, Administrator, who assisted with the visit. LPA explained the purpose of the visit.

The investigation consisted of the following:

On 09/27/2023, at 10:15am, LPA requested and obtained copies of the following documents: Resident and Staff Roster, ID/Emergency Information, Admission Agreement, Individual Service Plan, and Appraisal/Needs and Service Plan. LPA interviewed staff (S1-S4) and residents (R1-R7).

The investigation revealed the following: Allegation: Staff does not keep resident's room clean.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-20221212175410

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: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 09/27/2023

NARRATIVE

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On 09/27/23, from 10:00am-1:30pm, LPA interviewed S1-S4 and R1-R7. 4 of 4 staff denied the allegation that Staff does not keep resident's room clean. All staff stated that the rooms are cleaned daily. Additionally, S1 stated that the rooms get a deep cleaning once a month, on top of the daily cleaning. LPA toured the facility and resident’s room and did not observe the facility, nor the rooms toured to be dirty or unkempt. LPA interviewed R1-R7, and 7 of 7 residents interviewed, denied that Staff does not keep resident's room clean. All residents interviewed stated that the staff does keep their rooms cleaned.

Based on interviews and observations, there is insufficient evidence to support the allegation: Staff does not keep resident's room clean. 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.

Allegation #2: Staff does not treat resident with dignity or respect.

On 09/27/23, from 10:00am-1:30pm, LPA interviewed S1-S4 and R1-R7. 4 of 4 staff denied the allegation that Staff does not treat resident with dignity or respect. All staff confirm that they are treating all residents with dignity and respect. And to their knowledge, they state that no one has stated otherwise, or brought it to their attention. Additionally, S1 states that all staff are trained in personal rights of the residents and have in-service training yearly. LPA interviewed R1-R7. 7 of 7 residents interviewed denied that Staff does not treat resident with dignity or respect. All residents stated that indeed the staff does treat them with dignity and respect.

Based on interviews, there is insufficient evidence to support the allegation: Staff does not treat resident with dignity or respect. 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 at the conclusion of the investigation.

An exit interview was conducted, and a hard copy of this report was provided to Luz E. Rose, Administrator.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC9099 (FAS) - (06/04)

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