198320456-5-14-2025-11-AS-UCOL-DHZS5Z-20250626133510

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 05/14/2025
Date Signed: 05/14/2025 03:36:58 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
05/12/2025 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20250512114149

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: 88	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Manager Michele Brown		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not meet a resident's indwelling urinary catheter needs while in care
Staff did not provide adequate transportation for a resident

INVESTIGATION FINDINGS:

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On 05/14/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Terraza Court Senior Living and was greeted by Manager Michele Brown (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the finding pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Staff S1-S5, resident R1-R8. LPA Calderon obtained the following records: Admission Agreement (dated 04/22/2025), Physician Report (dated 04/22/2025), Providence Hospital Records (dated 05/11/2025), written statement from staff (dated 05/10/2025) for R1.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20250512114149

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: 05/14/2025

NARRATIVE

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Regarding the Allegation: Staff did not meet a residents indwelling urinary catheter needs while in care.

This complaint alleged that the facility did not fix or replace R1 catheter that was dislodged. Record review indicate the following: Admission agreement does not indicate that the facility is licensed to care for resident with catheter needs. Physician report indicates that R1 has health issues. Interviews indicate the following: 5 out of 5 staff deny the allegation. 5 out of 5 staff indicate the facility is not licensed or have staff that can take care of residents with catheter needs. 5 out of 5 staff indicate that home health care or hospice takes care of resident with catheter needs. R1 indicates that R1 does not remember having any issues or being taken to the hospital. 7 out of 8 residents indicate no need for home health care of hospice to take care of their needs.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not meet a residents indwelling urinary catheter needs while in care” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff did not provide adequate transportation for a resident.

This complaint alleged that the facility did not provide transportation for R1 to be taken to the hospital. Record review indicate the following: Admission agreement indicates page 4-part g “transportation” we will make available to residents or otherwise assure the provision of scheduled transportation to the nearest appropriate health facilities for medical and dental appointments. Reviewed S5 written statement for the incident that happened on 05/10/2025. S4 indicates that R1 was having health issues and S4 called 911. S4 indicates that the fire department refused to transport R1 for a non-emergency call. Interviews indicate the following: 5 out of 5 staff indicated that the facility does supply residents with transportation to the hospital, doctor office or dentist office. 5 out of 5 staff indicate that the fire department refused to transport R1 on 05/10/2025 for a non-emergency call. R1 does not remember being transported to the hospital. 7 out of 8 residents indicate that the facility does supply them with transportation to the hospital or for medical needs.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not provide adequate transportation for a resident” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report were provided to the Manager Michele Brown (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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