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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320456
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:34:24 AM

Document Has Been Signed on 01/14/2025 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
198320456
ADMINISTRATOR/
DIRECTOR:		KAVANAUGH, BRITTANYFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY: 170CENSUS: 79DATE:
01/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:18 AM
MET WITH:Brittany KavanaughTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 01/14/25 Licensing Program Analyst (LPA), Yolanda Rosser arrived at Terraza Court for an unannounced Case Management visit to follow up on a incident report received 12/03/24. LPA, Rosser introduced herself and met with Brittany Kavanaugh, Executive Director and explained purpose of visit. LPA, Rosser later met with Deeyanna Banda, Memory Care Director (MSG). LPA Rosser explained the purpose of the visit. Census is 79 of which 22 in Memory Care Unit. LPA toured facility.

LPA Rosser obtained and reviewed Personnel File for (S4) hire date 11/15/24 as a Caregiver. Criminal Background clearance was located in the file. (S4) application indicates job history, one previous employer since 03/24 Dental Front Office (position). Upon interview of Staff #2 (S2) Reference(s) were verified.

The Incident report indicated staff (S4) was verbally abusive to Resident #1 (R1) in memory care. (S3) reported incident to (S2).

LPA interviewed (S1) who did not witness incident and is unfamiliar with (S4). (S2) indicated (S4) was soft spoken and no indications of aggression was witnessed. The day of incident, (S4) was working an evening shift, which is not the normal shift of 6am - 2pm. (R1) was trying to leave memory care to find her parents. (R1) became agitated when (S4) tried to stop her from leaving memory care. (R1) called (S4) Fat, (S4) became very upset and began to verbally abuse her.

(S4) referred to (R1) as "ugly bitch", "you need to get your ass back in memory care".

(S2) indicated staff and resident were separated for the rest of the evening to ensure (S4) did not take things any further than a verbal altercation.

continued on 809C





SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/14/2025
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(S2) indicated a no tolerance policy for any type of abuse with residents. (S4) called out the following day after the incident and was subsequently terminated. (S3) was not working at the time of this visit therefore I was unable to obtain interview.

(R1) was unable to be interviewed based up memory level.

A copy of this report was provided to Executive Director.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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