198320456-4-23-2025-11-AS-EMAZ-DJA56U-20250704194120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 04/23/2025
Date Signed: 04/23/2025 02:48:50 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
04/14/2025 and conducted by Evaluator Yolanda Rosser

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250414111153

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: 87	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator,Brittany Kavanaugh		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Lack of supervision resulted in resident eloping

INVESTIGATION FINDINGS:

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On (04/23/25 at approx.11:00AM), Licensing Program Analyst (LPA’s) Yolanda Rosser and Alphonso Iniguez conducted a(n) initial visit on to gather information regarding the above allegation. LPA’s met with (Brittany Kavanaugh, Administrator and the purpose of the visit was explained. LPA’s was granted entry to the facility.

Investigation consisted of the following: On 04/23/25 LPA’s reviewed/obtained: Resident Roster (dated 04/18/25), staff roster (dated 04/23/25), (R1) Unusual Incident Report/Injury Report (dated 04/10/25), (R1)Physician’s Report for Residential Care Facilities for the Elderly (dated 03/25/25) and (R1) Durable Power of Attorney (dated 05/25/24). LPA’s conducted the following interviews: Administrator Interview (A1), Resident 1 interview (R1) and Facility Staff interviews (S1-S4).

Evaluation report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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-20250414111153

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: 04/23/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Lack of supervision resulted in resident eloping

The detail of the complaint alleges (R1) was found wandering on the street unassisted.

On 04/23/25 at approximately 2:00pm, LPA Rosser reviewed (R1) Unusual Incident /Injury Report dated 04/10/25, was having a behavioral episode, facility staff was always by (R1) side. (R1) decided to go out of the facility into the street, facility staff followed (R1) closely and redirected (R1) back into the facility. In addition, LPA Rosser observed (R1) Physician’s Report for Residential Care Facilities for the Elderly (dated 03/25/25). On the form it is marked that (R1) Secondary diagnosis impedes with her cognitive ability and it is not marked as a primary diagnosis.

On 04/23/25 at approximately 11:30 AM, during an interview with the Administrator, (A1), stated staff contacted her to inform that (R1) had a behavioral episode and ran into the street followed by facility staff (S4) who redirected (R1) back into the facility. In addition, (A1) stated that (R1) was never alone when they went out into the street.

On 04/23/25 at approximately 1:15 PM, during an interview with (R1) stated that they don’t recall the incident. However, (R1) stated they don’t go out of the facility alone, and they are always with someone.

On 04/23/25 at approximately 12:15PM, during interviews with facility staff (S1-S4), (4) out (4) stated that they witnessed (R1) have a behavioral episode and intervened when (R1) ran into the street and redirected (R1) back into the facility. In addition, (4) out of (4) facility staff stated that (R1) was never alone when they ran outside

Evaluation report continues on LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250414111153

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: 04/23/2025

NARRATIVE

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During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to
Brittany Kavanaugh/Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Yolanda Rosser
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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