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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 10/17/2025
Date Signed: 10/17/2025 09:39:05 AM

Substantiated


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
04/07/2025 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 11-AS-20250407120939
FACILITY NAME:TERRAZA COURT SENIOR LIVINGFACILITY NUMBER:
198320456
ADMINISTRATOR:KAVANAUGH, BRITTANYFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:170CENSUS: 104DATE:
10/17/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Michelle Brown-Wellness DirectorTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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#1-Allegation: Resident was physically abused while in care
#4- Allegation: Staff had inadequate record keeping for a resident
INVESTIGATION FINDINGS:
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This report supersedes the original report delivered on 6/23/2025.On 10/17/2025, LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 6/23/2025. Upon arrival LPA was assisted by Michelle Brown-Wellness Director.

On 6/23/2025, at 11:15 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the alleged allegation. LPA identified herself and met Brittany Kavanaugh-Administrator who was informed of the purpose of the visit.

The investigation consisted of the following:
On 04/15/2025 at 10:15 AM, LPA Allen obtained and reviewed files for Resident 1 (R1), which included face sheet dated, medication list, appraisal dated 4/20/2025, needs and services plans, physicians report, admissions agreement with personal property valuables list, staff and client roster dated April 2025, police report dated 4/6/2025, and after office visit medical summary dated 4/6/2025.
Continued
Substantiated
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 4
Control Number 11-AS-20250407120939
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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LPA Allen also conducted interviews with Staff 1- Staff 5 (S1 – S5), Residents 1 (R1), Witness 1 (W1) and attempted to interview Resident 2 (R2) along with observations of R1 physical signs of physical abuse, LIC624 dated 4/7/2025, interviews with Deeyanna Banda and Administrator Brittany Kavanaugh.

Investigation revealed the following:

#1-Allegation: Resident was physically abused while in care

On 4/15/2025, at 11:15 AM, LPA interviewed Staff 1- 5 (S1–S5). of those interviewed 5 out of 5 staff members reported that they did not witness R1 being physically assaulted by R2 and were unable to establish a timeline for the alleged incident. However, each staff member stated that they observed unexplained bruises on R1’s face immediately upon entering R1's room. Additional bruising to R1's abdomen was noted by staff within a few hours.

LPA Allen also interviewed R1, who stated that R2 punched them in the face, mouth, and stomach.

On 4/16/2025, at 3:00 PM, LPA received and reviewed the Culver City Police Department (CCPD) report. The report confirmed that R1 reported being physically assaulted by R2. The medical assessment revealed R1 sustained abrasions to the face, a swollen left eye, injuries to the upper and lower lip, a skin tear on the left elbow, a hematoma to the head, neck and back pain upon palpation, chest pain, and bruising to the stomach. R2 admitted to the assault during their interview with CCPD and was subsequently arrested. R1 was transported by EMS to the Emergency Room (ER) for further evaluation.

LPA attempted to conduct a file review for R2 but was unable to do so, as the facility failed to complete a pre-admission assessment to determine the resident’s care and supervision needs.

Based on observations, staff interviews, and records reviewed, it was determined that the facility failed to provide proper supervision of R2, resulting in the assault on R1 and causing R1 to sustain multiple injuries.

#4- Allegation: Staff had inadequate record keeping for a resident-

On 4/15/2025, at 11:15AM, LPA interviewed Staff 1- 5 (S1-S5), of those interviewed 5 out of 5 stated upon the paramedic’s arrival, no records or medical information were available for residents R1 or R2.

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: 3 of 4
Control Number 11-AS-20250407120939
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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The interviews conducted with Memory Care Director Deeyanna Banda and Administrator Brittany Kavanaugh both stated that no records had been prepared for either resident prior to the altercation. When LPA arrived at the facility and inquired about the absence of records, Deeyanna and Brittany explained that R1 and R2 were newly admitted as displaced individuals who arrived without any identification, medical history or documentation. As a result, their files were not created until after the incident occurred.

Based on the evidence gathered during the investigation of record review, interviews and observations the above allegations are found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where this report was discussed and provided to Brittany Kavanaugh- Administrator, at the conclusion of the visit with appeal rights. Per Administrators’ approval, Joseph Wieder was authorized to sign the report.

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 4
Control Number 11-AS-20250407120939
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2025
Section Cited
CCR
87468.2(a)
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87468.2 -Additional Personal Rights of Residents in Privately Operated Facilities.(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, or sexual abuse.
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The licensee has agreed to provide training to all staff members regarding the personal rights of all residents in care which should include a statement of understanding signed by all staff members. This information will be emailed to LPA by the POC date of 06/25/2025.
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This requirement was not met as evidenced by: Based on record review, interviews and observations the licensee failed to comply with the section above by not providing proper supervision which resulted in R1 being assaulted by R2 on 4/6/2025 which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
09/30/2025
Section Cited
CCR
87506(a)
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87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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The licensee has agreed to provide a complete file for R1and R2. along with a statement of understanding of the cited regulations to ensure that all residents files are availiable at all times. This information will be emailed to LPA by the POC date of 06/25/2025
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This requirement was not met as evidenced by: which poses an immediate health, safety or personal rights risk to persons in care. During LPA Allen investigation the Adminstrator did not have R1 or R2 files availiable for paramedics or LPA during investigation visit.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4