198320197-9-11-2023-11-AS-MVAO-CYY4HS-20231228180734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 05/30/2023
Date Signed: 09/11/2023 11:49:34 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
02/03/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20230203101540

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: 65	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	VIRGINIA ZENTENO		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff injured resident.
Staff made inappropriate comments to resident.
Staff did not assist resident in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 5/30/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit at this facility to gather and deliver complaint investigation findings. LPA met with Administrator Virginia Zenteno who assisted with the visit. LPA explained the purpose of the visit.

The investigation consisted of the following: On 2/7/2023, LPA Montoya conducted a tour of the physical plant. LPA interviewed four staff (S1-S4) and six residents (R1-R6). LPA requested and obtained a client roster, staff roster, and Resident #1’s service records (Admission Agreement, Physician’s Report, Appraisal and Incident Reports). LPA attempted to interview via phone the staff who was reported as the alleged perpetrator, but LPA was unable to reach the staff. On 5/30/2023, LPA attempted again to interview the alleged perpetrator but the staff was not present in the facility during the visit.

Report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20230203101540

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: 05/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATIONS REVEALED:

Based on records reviews, R1 was admitted to the facility on 2/10/2022. R1 is ambulatory. R1 is self- responsible, able to self-care, able to communicate needs and able to follow instructions.

Regarding allegation: Staff injured resident.

It was alleged that staff twisted victim's thumb that resulted in an injury. The department interviewed four staff (S1-S4) and six residents (R1-R6). During interviews, it was mentioned that staff twisted R1’s finger in the middle of the night but S1-S4 and R2-R5 denied the allegation that staff injured residents in care. Records review revealed that on 12/3/2022, R1 hit a staff with a cane for intervening in a dispute between R1 and another resident. It was not noted on this incident report that staff hit or injured R1. Based on gathered information, there is no sufficient evidence to corroborate the above allegation.

Regarding allegation: Staff made inappropriate comments to resident.

It was alleged that a staff called resident a "religious whore" and another staff told resident to kick resident out of the facility if resident reports any abuse." The department interviewed four staff (S1-S4) and six residents (R1-R6). During interviews, it was mentioned that staff made inappropriate comments to R1 but unable to state what staff commented. S1-S4 and R2-R5 denied the allegation that staff made inappropriate comments to residents in care. Based on records review, on 12/5/2022, an incident was reported that R1 asked another resident to help get rid of staff who caused the resident trouble. There is no record of an incident that staff made inappropriate comments to residents. Based on gathered information, there is no sufficient evidence to corroborate the above allegation.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230203101540

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: 05/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

This page was amended to revise the report regarding the allegation "Staff did not assist resident in a timely manner.

Regarding allegation: Staff did not assist resident in a timely manner.

It was alleged that staff did not assist resident in a timely manner when a resident slipped in the bathroom and staff left resident bleeding on the floor. The department interviewed four staff (S1-S4) and six residents (R1-R6). During the interview, R1 stated R1 fell in the bathroom and R1 pulled the emergency pull cord for help but staff did come until an hour later. Then 911 was called. S2 revealed during an interview that about three weeks ago, R1 pulled the emergency cord for help when R1 fell in the bathroom. S2 stated S2 immediately checked on R1 in the bedroom and found R1 out of the bathroom. S2 revealed R1 disclosed to S2 that R1 fell about two to three hours ago and did not pull the emergency cord for help right away. S2 immediately checked R1’s body and found no signs of pain, no bruises, or cuts. S1-S4 and R2-R6 denied the allegation that staff did not assist resident in a timely manner. Based on gathered information, there is no sufficient evidence to corroborate the above allegation.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Virginia Zenteno and a hard copy was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3