198320456-10-17-2025-11-AS-SCIS-DN75XG-20251106192045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 10/17/2025
Date Signed: 10/17/2025 02:26:19 PM

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
06/16/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20250616185252

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: 104	DATE:	10/17/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Michelle Brown- Wellness Director		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not ensure that resident was receiving catheter care

INVESTIGATION FINDINGS:

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On 10/17/2025, at 9:45 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the alleged allegation. LPA identified herself and met with Michell Brown-Wellness Director who was informed of the purpose of the visit.

The investigation consisted of the following:
On6/23/2025 at 9:00 AM, LPA Allen obtained pertinent documents for Resident 1(R1) Admissions Agreement, Home Health Resident Assessment Plan dated 4/20/2025, Physicians Report dated 3/4/2025. Patient Orders dated 6/14/2025, Connect HealthCare Notes dated 4/25/25, 4/29/25, 5/1/25, 5/6/25,5/12/25,5/20/25, and 5/27/25. These records revealed that staff members are educated about providing catheter care/cleaning on each visit. Dazzle Health P.C. dated 3/22/25 and 3/27/25, Dignity Health-California records, Hospital Medical Center record dated 12/15/24. Identification and Emergency Information, Pre-appraisal, telecommunication device notification dated 3/7/2025, Staff training dated 6/11/2025, Medication list, Notes including doctors’ visit/Emergency room visits date 12/15/2024,
Continued.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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 3

Control Number 11-AS-20250616185252

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: 10/17/2025

NARRATIVE

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Southern California Hospital at Culver City patient order history dated 6/18/2025, and home health notes dated 4/20/2025-5/27/2025 and LPA Allen also conducted an interview with R1.

The investigation revealed the following:

On 06/26/2025, LPA reviewed R1’s home health notes dated 04/20/2025 – 05/27/2025, which revealed that facility staff ensured R1 received catheter cleaning/care from Terraza Court facility staff, in addition to care provided by Connect HealthCare. Connect HealthCare notes dated 04/25/2025, 04/29/2025, 05/01/2025, 05/06/2025, 05/12/2025, 05/20/2025, and 05/27/2025 were reviewed. Connect HealthCare documentation further indicated that both caregivers and patient were educated and informed about catheter cleaning/care and demonstrated comprehension of the information provided during each visit.Records also revealed that R1 has a history of medical complications due to manipulating the catheter against medical advice.

At 10:00 AM on 10/17/2025, LPA conducted interviews with Residents 1- 7 (R1–R7). Of those interviewed, 1 out of 7 residents stated they receive assistance with catheter cleaning/care and understand the information provided by the nurse during visits. R2, R3, and R4 also stated that staff members assist them with their care. LPA attempted to interview R5, R6, and R7; however, they were unable to engage in a clear conversation.

LPA also interviewed Staff Members 1- 6 (S1-S6) Of those interviewed, 6 out of 6 staff members stated that residents are assisted with their care needs, including catheter cleaning/care. Staff also reported understanding their responsibilities when providing catheter cleaning/care and confirmed they comprehend the information provided by the nurse during visits.

Additionally, staff acknowledged that if further medical care is needed by a medical professional residents are either sent out for medical visits or home health professionals are contacted for facility visits. LPA also observed training documents for catheter cleaning/care signed by staff members dated 6/11/2025.

Records revealed that R1 received catheter cleaning/care from both medical professionals and facility staff from the date of admission on 03/10/2025 until the discharge date of 09/08/2025 from Connect Healthcare.

Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250616185252

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: 10/17/2025

NARRATIVE

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Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. which means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted, during which this report was discussed and provided to Michelle Brown- Wellness Director at the conclusion of the visit, along with appeal rights.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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