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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 08/11/2022
Date Signed: 08/11/2022 02:57:41 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
08/05/2022 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220805111946
FACILITY NAME:PLAZA AT WESTWOOD, THEFACILITY NUMBER:
198320197
ADMINISTRATOR:KELLEY KOULFACILITY TYPE:
740
ADDRESS:2228 WESTWOOD BLVDTELEPHONE:
(323) 217-7877
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:136CENSUS: 57DATE:
08/11/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Theresa Pascual , Wellness DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility mismanaged resident's medical information.
Facility is not ensuring that resident receives physical therapy services.
INVESTIGATION FINDINGS:
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On 08/11/2022, Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation to address the allegations listed above. LPA Agard met with Theresa Pascual, Wellness Director and explained the purpose of this visit is to gather information for the complaint and deliver findings.

On 08/10/2022, the investigation consisted of the following: LPA Agard conducted a tour of the facility grounds. Facility is a 68 resident-bedroom, approx.74-bathroom, three-story building. 1st floor consists of a lobby area, laundry facility, staff break room and an adjacent parking structure. 2nd floor consists of residential rooms, dining room, kitchen, outdoor patio, media room and medication room. LPA interviewed staff and residents, reviewed records, and delivered findings. LPA Agard requested the following documents: 1) A copy of the staff roster, 2) a copy of the resident roster with their date of birth, 3) Needs and Services plans for R1, 4) Medication Administration Records for R1 for the month of June, July, and August 2022, 5) Physicians report for R1, 6) Any fax cover letter confirmations for R1, 7) Chart or progress notes for R1.

Cont. on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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-20220805111946
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: 08/11/2022
NARRATIVE
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On 08/11/2022, LPA delivered findings.

The investigation revealed the following: Regarding the allegation: Facility mismanaged resident's medical information. “It’s being alleged that medical results requested are not being provided.” On 08/10/2022 LPA interviewed 5 out of a total of 56 residents. 0 out of 5 residents could not confirmed the allegation to be true. R1 states, “They don’t mismanage my medical information. I worked for a hospital for 13 years, I know a lot of medical terminology. If I see something wrong, I correct it.” R2 was unable to answer the question. R4 states, “my medical stuff is mostly handled by me and my doctor. Sometimes, S1 coordinates things to help out but it’s mostly me and there are no issues.” R5 states, “I take care of my medical needs. They do provide transportation but as far as appointments I do them myself. There are no issues for me.”

During interviews with staff, LPA interviewed 4 out of 37 in total. 0 of the 4 could not confirmed the allegation to be true. S1 states, “the Assisted Living Wavier Program (ALW) has asked for a blood work report and I faxed it on August 1st. It could have been on the 3rd, but it was sent to W1. ALW requested information regarding the new doctor’s information. It was sent with the request for the blood work report.” S2 states, “I speak to W1 and another person from Partners in Care. They call and email me with anything they want, and we send it.” S3 and S4 were all unable to confirm the allegation to be true or not.

The investigation revealed the following: Regarding the allegation: Facility is not ensuring that resident receives physical therapy services. “It’s being alleged that physical therapy was recommended but the facility failed to comply.” On 08/10/2022 LPA interviewed 5 out of a total of 56 residents. 0 out of 5 residents could not confirmed the allegation to be true. R1 states, “Yes I am, I’m still getting physical therapy. It stops sometimes and then I have to be re-evaluated. It’s just starting again. They came last week to re-evaluate me.” R2 was unable to answer the question. R3 and R4 were unable to speak to the allegation due to their ability to handle their medical needs. R5 states, “I receive PT twice a week. It starts and stops due to Medicare. They have to reassessed and sometimes it takes time.”

During interviews with staff, LPA interviewed 4 out of 37 in total. 0 of the 4 could not confirmed the allegation to be true. S1 states, “R1 is bed bound and alert. They had physical therapy in the past, in the beginning of the year. With Medicare you only get so many visits. S2 states, “I would love to have all residents in physical therapy, but Medicare determines how long the resident will get it. The doctor is the one to request it. We have nothing to do with that.” S3 and S4 were all unable to confirm the allegation to be true or not.

Cont on 9099C

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20220805111946
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: 08/11/2022
NARRATIVE
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On 08/11/2022, LPA Agard reviewed the following records: a staff roster dated July 2022. All staff interviewed matches with roster. A resident roster dated August 2022. All residents interviewed matches with the roster. LPA reviewed a fax cover sheet and fax journal report dated 08/07/2022 that confirms information was faxed on 08/01/2022 to Partners in Care, the Assisted Living Wavier Program at 1:42pm. LPA reviewed R1’s physicians report and face sheet dated for 08/06/2021, which matches the diagnosis of R1. LPA Reviewed the medication administration records for R1 for the months of June, July, and August of 2021 and observed R1 to be receiving medication that matches their diagnosis. LPA reviewed a post discharge plan of care dated 09/17/2021 for R1 from their previous accommodations that contains a list of medications which matches the medication administration records utilized by the facility currently. LPA reviewed a Physical Therapy evaluation and Plan of Care from Epic dated 08/11/2022. The report from 07/12/2022 shows R1 had been re-evaluated for physical therapy services. On 07/26/2022 the reports indicate R1 has received a functional assessment and has been approved for 5 visits.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations 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 CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3