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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 06/13/2022
Date Signed: 06/16/2022 09:03:27 AM

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
06/08/2022 and conducted by Evaluator Pamela Bunker
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220608105003
FACILITY NAME:PLAZA AT WESTWOOD, THEFACILITY NUMBER:
198320197
ADMINISTRATOR:KOUL, KELLYFACILITY TYPE:
740
ADDRESS:2228 WESTWOOD BLVDTELEPHONE:
(323) 217-7877
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:136CENSUS: 54DATE:
06/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kelley KoulTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not following COVID-19 procedures
Staff are retaliating against resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, June 13, 2022. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is not cleared of COVID-19 infection. LPA Bunker met with Administrator Kelley Koul. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-3 (S1-S3) and residents 1-6 (R1-R6). LPA Bunker asked questions relevant to the nature of the complaint. S1-S3 and R2-R6 stated staff does assist residents with their daily needs as needed. S1-S3 and R2-R6 stated the facility is following COVID-19 procedures and staff are not retaliating against residents. S1-S3 stated the facility does mass COVID-19 testing for the staff and residents weekly. If a staff or residents have positive results it is reported to all the appropriate agencies timely. LPA Bunker requested copies of supporting documents.

See continued LIC9099-C page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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-20220608105003
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: 06/13/2022
NARRATIVE
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Continued LIC9099-C page 2

Allegation #1 Staff are not following COVID-19 procedures: S1-S3 and R2-R6 interviewed stated staff is following COVID-19 procedures. If there are positive COVID-19 results all team members, residents, families, responsible parties, visitors, and appropriate agencies are notified immediately via letter. LPA observed the facility has an approved Mitigation Plan Report on file. Administrator Kelley Koul stated the facility is following the Mitigation and Infection Control Plan. S1-S3 stated the facility will call the resident's family, and send email letters, the residents are notified door to door with a memo letter, and it is posted at the receptionist desk and throughout the facility if a resident or staff test results are positive for COVID-19. Ms. Koul stated everyone is notified if there is a positive COVID-19 case. If staff and residents had any questions staff is available to answer questions.

Allegation #2 Staff are retaliating against residents: S1-S3 and R2-R6 interviewed stated staff does not retaliate against residents complaining about things at the facility. R2-R6 stated they are happy residing at the facility and their care needs are being met. R2-R6 stated staff is available to assist residents if there are any questions, issues, problems, or concerns. S1-S3 stated residents are assisted with their daily living, and staff is providing the necessary care and supervision to meet residents' needs

Investigation revealed the following: Interviews were conducted with staff 1-3 (S1-S3), and residents 1-6 (R1-R6). S1-S3 and R2-R6 stated COVID-19 positive residents are not being kept in the room with COVID-19 negative residents. S1-S3 and R2-R6 stated that staff and residents are wearing masks. LPA Bunker observed staff and residents with their masks on during today's visit. The administrator stated staff is not going in and out of positive COVID-19 residents' rooms into negative COVID-19 residents' rooms. Ms. Koul stated if there is a positive COVID-19 resident they are assigned to a Med Tech. Ms. Koul stated the Med Techs give residents their medication and their COVID-19 tests. The caregivers deliver the food to residents. Ms. Koul stated all staff and residents are tested and notified if the test result is positive for COVID-19. Ms. Koul stated if a resident is out when the facility is doing mass COVID-19 testing the Med Techs will test the resident when they return back to the facility. Ms. Koul stated The facility is adequately staffed and the facility staff is trained, qualified, and competent to do their jobs and receives ongoing training. LPA reviewed the facility’s surveillance testing records.
See continued LIC9099-C page 3
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20220608105003
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: 06/13/2022
NARRATIVE
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Continued LIC812-C page 3

LPA verified that the facility has an approved Mitigation Plan Report. Administrator Kelley Koul stated some of the staff and all residents are fully vaccinated. The facility has the ability to quarantine either non-symptomatic or positive COVID-19 residents. Ms. Koul stated the facility is following all guidance and direction regarding infection control protocol. Ms. Koul stated that whenever they receive a positive COVID-19 test result it is reported to all the appropriate agencies, Community Care Licensing, Los Angeles County Department of Public Health, resident's families, responsible parties, staff, residents, and visitors are notified immediately. S1-S3 and R2-R6 stated staff does not retaliate against residents for complaining about things against the facility. S1-S3 and R2-R6 stated the allegations are false. Staff 1-3 (S1-S3) and residents 2-6 (R2-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-Cs, was provided to Administrator Kelley Koul.

There were no deficiencies cited.

An exit interview was conducted.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3