198320456-9-16-2025-11-AS-EMAZ-DLYVU2-20250929164402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 09/16/2025
Date Signed: 09/16/2025 11:57:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250310122319

FACILITY NAME:	TERRAZA COURT SENIOR LIVING		FACILITY NUMBER:	198320456
ADMINISTRATOR:	KAVANAUGH, BRITTANY		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	170	CENSUS: 71	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Deeyanna Banda/Med Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek medical attention for resident in care in a timely manner.
Staff did not ensure that resident was provided with a comfortable environment whle in care.

INVESTIGATION FINDINGS:

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

On 9/16/2025 at approximately 10:00 AM, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Deeyanna Banda/Med Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Care MC Director Interview (A#1), Residents Interviews (R#1-R#7) and Staff Interview (S#1-S#2). LPA obtained and reviewed the following documents: Resident Roster dated: 8/7/25, Staff Roster dated: 8/7/25, copy of (R#1)’s Unusual Incident Report dated: 3/8/25, copy of (R#1)’s, copy of facility staff (S#2) email regarding (R#1)’s incident dated:3/10/25, copies of facility progress notes dated: 3/6/25 and 3/8/25, copy of Med Tech Communication Log dated: 3/7/25, copy of (R#1) resident assessment dated: 3/7/25, copy of (R#1)’s discharge hospital records dated:3/7/25, copy of (R#1)’s Physicians Report for Residential Care Facilities for The Elderly (RCFE) or LIC 602A dated:3/7/25.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

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 4

Control Number 11-AS-20250310122319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: TERRAZA COURT SENIOR LIVING	FACILITY NUMBER: 198320456
	VISIT DATE: 09/16/2025

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

Investigation Revealed the Following:

Allegation: Staff did not seek medical attention for residents in care in a timely manner.

The details of the complaint alleged that facility staff did not seek medical attention for (R#1) in a timely manner.

On September 16, 2025, at approximately 10:30 a.m., during the records review, LPA Iniguez observed a copy of the Culver City Fire Department Incident Report dated 3/7/25. LPA Iniguez observed that the report states that on the night of 3/7/25 at approximately 11:31 p.m., the emergency department was dispatched to the facility regarding (R#1). When the emergency department arrived at (R#1)’s room, emergency personnel spoke with (R#1), who denied any medical complaint. (R#1) stated that they were very uncomfortable because they needed an adjustable bed, and the facility did not have one. Emergency personnel took (R#1) to the hospital.

On August 7, 2025, at approximately 10:00 AM, during an Interview with the Administrative Assistant (A#1), she stated that (R#1) was only one day with us at the facility. (R#1) was taken to the hospital for further care and evaluation. In addition, (A#1) stated that the facility did not use Uber or Lyft to transfer (R#1) to the hospital; the emergency department came on the night of 3/7/25 and took them back to the hospital.

On August 7, 2025, at approximately 11:25 am, Licensing Program Analyst-LPA Alfonso Iniguez contacted former resident (R#1), they answered the call and LPA Iniguez introduced himself, (R#1) stated that they do not have time to take the call since they are at the hospital and they do not want to talk about it. LPA Iniguez thanked (R#1) for their time and ended the call.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250310122319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: TERRAZA COURT SENIOR LIVING	FACILITY NUMBER: 198320456
	VISIT DATE: 09/16/2025

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

On August 7, 2025, at approximately 12:00 PM, during an interview with residents in care (R#2-R#7), (6) out of (7) stated that they feel the facility staff are trained in case they need emergency medical services. In addition, (6) out of (7) residents in care stated that they feel the facility staff will call the emergency department in case they need it.

On August 7, 2025, at approximately 1:00 PM, during an interview with facility staff (S#1-S#2), (2) out of (2) stated that (R#1) was only one night at the facility and they did not attempted to take them to the hospital using an Uber or Lyft, the emergency department came an took (R#1) to the hospital.

Allegation: Staff did not ensure that residents were provided with a comfortable environment while in care.

The details of the complaint alleged that (R#1) spent the night on their wheelchair.

On September 16, 2025, at approximately 10:30 a.m., during the records review, LPA Iniguez observed a copy of the hospital discharge records dated 3/7/25. LPA Iniguez observed that (R#1) did not have an order for a hospital bed.

On August 7, 2025, at approximately 10:00 AM, during an Interview with the Administrative Assistant (A#1), she stated that (R#1)’s bed was clean and in good condition when they arrived at the facility; it was not soiled. In addition, (A#1) stated that (R#1) did not sleep in their wheelchair the whole night. When (R#1) arrived at the facility, they requested a hospital bed. We told (R#1) that such a bed is considered medical equipment and needs a doctor’s order. When (R#1) found out we could not provide the hospital bed that night, they refused to use the facility bed. Later that night, facility staff informed me that (R#1) slept on the facility’s bed.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250310122319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: TERRAZA COURT SENIOR LIVING	FACILITY NUMBER: 198320456
	VISIT DATE: 09/16/2025

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

On August 7, 2025, at approximately 12:00 PM, during an interview with residents in care (R#2-R#7), (6) out of (7) stated that the facility provides a comfortable environment for them and the rest of the residents in care. In addition, (6) out of (7) residents in care stated that they feel comfortable living at the facility.

On August 7, 2025, at approximately 1:00 PM, during an interview with facility staff (S#1-S#2), (2) out of (2) stated that (R#1)’s bed was clean and in good condition when they arrived at the facility; it was not soiled and they did not sleep in their wheelchair the whole night.

During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Michelle Brown/Wellness Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4