198320456-12-15-2025-11-AS-SCIS-DPF3ZM-20251216174147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 08/22/2025
Date Signed: 12/15/2025 12:16:01 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20250714101031

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: 109	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Michelle Brown, Wellness Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee did not ensure that resident was reassessed as necessary while in care.

INVESTIGATION FINDINGS:

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On August 22, 2025, Licensing Program Analyst (LPA) Pamela Bunker conducted a subsequent visit to gather information regarding the above allegations. LPA met with Michelle Brown, Wellness Director, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of the following: On August 22, 2025, the following documents were reviewed and/or obtained as part of the investigation: Personnel Report (dated 08/22/2025), Resident Roster (dated 08/22/2025), Special Incident Reports (dated 10/24/2024), Admission Agreement (dated 03/15/2022) Identification and Emergency Information (dated 03/16/2022), Physician’s Report (dated 07/13/2022, 07/25/2023 & 10/02/2024), Medical Assessment (dated 03/09/2022), Medication Administration Records (MARs) (dated 10/24/2024 & 11/20/2024), Appraisal & Needs and Services Plan (dated 05/14/2024), Functional Capability Assessment (dated 07/13/2022), Preplacement Appraisal Information (dated 07/13/2022), Personal Rights (dated 03/12/2022), Consent Forms (date 03/12/2022), Resident Assessment (dated 03/15/2022), See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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-20250714101031

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT SENIOR LIVING	FACILITY NUMBER: 198320456
	VISIT DATE: 08/22/2025

NARRATIVE

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Continued LIC9099-C page 3

AL Advantage Resident Assessment (dated 02/24/2022 & 03/09/2022).

Interviews were conducted with Staff Members #1–6 (S1–S6) and Resident #2-6 (R2-R6)

Resident #1 (R1) was unavailable for an interview as they no longer reside at the facility. R1 passed away on December 21, 2024, after transferring to another care facility.

The investigation revealed the following.
Allegation: Licensee did not ensure that the resident was reassessed as necessary while in care.

LPA interviewed Staff #1–6. All six staff members (6 out of 6) stated that the facility staff ensure residents are reassessed as necessary while in care. 6 out of 6 staff members also reported that there was no reason for the resident to be reassessed, as the previous assessment was up to date and there had been no change in R1's condition requiring reassessment. All six (6 out of 6) staff members denied the allegation.

A review of R1’s file, including the Physician’s Report (dated 07/13/2022, 07/25/2023 & 10/02/2024), Medical Assessment (dated 03/09/2022), Medication Administration Records (MARs) (dated 10/24/2024 & 11/20/2024), Appraisal & Needs and Services Plan (dated 05/14/2024), Functional Capability Assessment (dated 07/13/2022), Preplacement Appraisal Information (dated 07/13/2022), and Resident Assessment (dated 03/15/2022) did not indicate resident need to be reassessed. The resident did not have a change in condition.

LPA interviewed Residents #2-6 (R2–R6). Five (5 out of 6) residents stated that staff ensure residents are reassessed when needed during their care. Five (5 out of 6) residents denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the Wellness Director, Michelle Brown. An exit interview was conducted. No deficiencies were cited.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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