198320456-3-12-2025-11-AS-RORN-DEXTPG-20250320145419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 03/12/2025
Date Signed: 03/12/2025 02:33:59 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
12/03/2024 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241203134527

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: 80	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	Brittany Kavanaugh - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not providing resident's responsible party with requested records.

INVESTIGATION FINDINGS:

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On 03/12/2025 Licensing Program Analyst (LPA) Troy Watson conducted a subsequent visit to deliver findings to the facility mentioned above. LPA met with the Administrator Brittany Kavanaugh and explained the purpose of the visit. LPA was granted entry into the facility.

The investigation consisted of the following:On 12/12/2024 the department conducted interviews with staff members 1-2 (S1-S2). LPA requested and reviewed the resident's records and asked for copies of the following documents: Personnel report, Resident Roster, Special Incident Reports, Admission Agreement, Identification and Emergency Information, Physician's Report, Medical Assessment, Medication Administration Records (MARs), Medication Logs, Appraisal Need and Services Plan, Safeguards for Cash Resources, Preplacement Appraisal Information, Safeguards for Property Valuables, Personal Rights, and Consent Forms.

CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241203134527

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: 03/12/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Staff are not providing the resident's responsible party with the requested records.

12/12/2024 the department spoke with Administrator Brittany Kavanaugh. Per administrator, facilities legal team had received certified mail from a Law Office requesting a resident's medical records. Administrator stated Terraza Court Senior Living's legal team replied to the law office and sent them the requested documents.On 12/12/2024 facility provided LPA Bunker with copies of the documents that was submitted to the law office as well as email correspondence dated 11/07/2024 at 1:26 P.M., 11/12/2024 at 10:34 A.M., 12/02/2024 at 8:52 A.M.,and on 01/03/2025 at 9:03 A.M.. On 02/26/2025 LPA Bunker contacted the law office via telephone and confirmed the documents had been received.

Based on interviews conducted, the department did not find 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 unsubstantiated.

There were no deficiencies cited.

An exit interview was conducted with the Administrator Brittany Kavanaugh and a hard copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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