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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320197
Report Date: 10/06/2023
Date Signed: 10/30/2023 01:17:04 PM


Document Has Been Signed on 10/30/2023 01:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:PLAZA AT WESTWOOD, THEFACILITY NUMBER:
198320197
ADMINISTRATOR:VIRGINIA ZENTENOFACILITY TYPE:
740
ADDRESS:2228 WESTWOOD BLVDTELEPHONE:
(323) 217-7877
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:136CENSUS: 62DATE:
10/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Luz RoseTIME COMPLETED:
03:30 PM
NARRATIVE
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On 10/06/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management inspection visit at this facility. LPA met with Executive Director Luz Rose and explained the purpose of the visit.

During an investigation visit on 10/06/23 associated with complaint #11-AS-20230829161007, LPA was informed that incidents involving resident #1 (R1) were not reported to Community Care Licensing (CCL) on a LIC 624. According to the facility's internal incident reports, there were a total of (27) incident reports from 12/17/21 through 09/17/23.

The facility issued the 30-day Notice to Vacate to (R1). A copy of the Eviction Notice was sent to (CCL) on 02/15/23. Licensing Program Manager Ulysses Coronel notified in writing the facility failed to meet Title 22 Division 6 Chapter 8, Article 04 Operating Requirements, 82744 Eviction Procedures is not met. In the letter, it stated that the facility in not in compliance with Title 22 Regulations 87244(d)(1)(A-D). The facility needed to make the necessary corrections and resubmit for approval. The facility never resubmitted with the corrections and just proceeded with the eviction. The facility did not allow for the Department to investigate the reason for the Eviction Procedures. The notice was determined to be invalid.

Based on the information provided by the administrator, the facility violates the California Code of Regulations (Title 22, Division 6, Chapter 8), deficiencies were observed, and citations were issued (ref. LIC 9099-D).

An exit interview was conducted and a copy of the Evaluation Report and Appeal Rights were provided to Luz Rose.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/30/2023 01:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2023
Section Cited
CCR
87211(a)(1)(A-D)(b)

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87211 Reporting Requirements (a) licensee shall furnish to the licensing agency such reports as the Department... (1) A written report shall be submitted to the licensing agency... within seven days...(A) Death of any resident from any cause regardless of where the death occurred...
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Licensee will adhere to the regulations and will ensure any unusual incidents or change in condition or death will be reported to CCLD. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 10/20/23
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This requirement is not met as evidence by: Based on interview, Licensee failed to report incident involving R1. This violation possesses a potential Health and Safety risk to residents in care.
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Type B
10/20/2023
Section Cited
CCR87224(d)(1)(A-D)

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Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons...
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Licensee will adhere to the regulations and will ensure to review Title 22 87224. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 the regulations was reviewed to El Segundo Regional office by 10/20/23.
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This requirement is not met as evidence by: Based on interview, Licensee failed to resubmit eviction notice corrections for department approval and proceeded with (R1's) eviction. This violation possesses a potential Health and Safety risk to residents in care.
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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 HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
LIC809 (FAS) - (06/04)
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