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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320456
Report Date: 06/11/2025
Date Signed: 06/12/2025 10:58:29 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
06/06/2025 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250606092721
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: 107DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:BRITTANY KAVANAUGHTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility overcharged resident.
Facility staff is not answering communications from resident’s representative.
Facility staff has not provided a copy of admission agreement to resident's responsible person.
INVESTIGATION FINDINGS:
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On June 11, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a visit to gather information regarding the above allegations. LPA met with BRITTANY KAVANAUGH the Executive Director, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of interviews, and records were collected with staff members #1 to #2 (S1-S2) and resident member #1(R1). List of documents reviewed/obtained Resident Roster (dated 06/11/25), Facility Staff Roster (dated 06/11/25), (R1)'s Physicians Report LIC 602A (dated 03/19/25), Resident Appraisal (dated 03/19/25), Identification and Emergency Information LIC 601 (dated 03/19/25), and other pertinent documents associated with this complaint.

(Evaluation Report continues LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
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 6
Control Number 11-AS-20250606092721
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: 06/11/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Facility overcharged resident.

The facility is accused of overcharging Resident #1 (R1) for services. According to the report, (R1) moved into the facility on April 8, 2025, and was billed for the entire month. (R1) has two charges listed for May 5, 2025, and May 19, 2025. It is reported that (R1) receives SSI/SSP income and should only be charged $1,420.07 monthly.

A review of Resident #1's (R1) Admissions Agreement (dated March 19, 2025) shows that (R1) 's representative signed the agreement on that date. On page six, Section VI - Fees Subsection A – Monthly Fee indicated $1292.40 for fee for residential services for (R1).

On June 11, 2025, between 10:00 AM and 10:15 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) claimed not to know the financial intricacy and was uninterested. (R1) stated that (R1) 's family representative handles finances and payments.

On June 11, 2025, between 10:15 AM and 11:00 AM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). (S1) verified that (R1)’s resident agreement signing of documents were performed on March 19, 2025. However, the (R1) did the fully take possession of a room until April 8, 2025. (S1-S2) stated that (R1) should have not been charged the full amount of $1,292.40 from April 1, 2025, through April 7, 2025. (S1) was unaware for the reported duplicate charges for May 5, 2025, and May 19, 2025. (S2) assumed the duplicate charge was for the preadmission for the month of March 2025 but later discovered that (R1) did not occupy the room for the March and should have not be charged the duplicate amount of $1292.40 in May 2025. (S1-S2) both verified there is an error in billing, and it was not intentional.

The Department reviewed invoices Facility Transaction Log (dated June 11, 2025) from March 1, 2025, through June 5, 2025, and revealed (R1) was billed for March 2025. Payments for April 2025 were applied to the March 2025 invoice, leaving (R1)’s account in the rears. Individual invoices from March through June indicate being paid in full. Nonetheless, the invoice for May 2025 did not list itemized services or charges to indicate the two charges for May 2025.

Based on the information gathered, there is sufficient evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20250606092721
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: 06/11/2025
NARRATIVE
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Allegation #2: Facility staff is not answering communications from resident’s representative.

It is alleged that the facility staff is not responding to communications from Resident #1 (R1)'s representative. It has been reported that Staff #1 (S1) has not addressed the issue of (R1) being overcharged twice for the month of May 2025 for services.

On June 11, 2025, between 10:00 AM and 10:15 AM, the Department interviewed resident member identified as Resident #1 (R1). (R1) claimed to have no knowledge of any issues with the charges for services. (R1) is unaware if any facility staff have had any communication regarding this matter with (R1)’s family representative.

On June 11, 2025, between 10:15 AM and 11:00 AM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). (S1) acknowledged several text messages from (R1) 's representative in late May 2025. (S1) stated in the text messages that (S1) responded to the text messages to (R1) 's representative with messages from May 26, 2025, through May 28, 2025, of the following: "I will call you back in a few minutes," "In a signing, will call you back shortly," and "I will call you back shortly." Despite earlier assurances, (S1) confessed to neglecting the follow-up call to (R1)’s representative, which had been promised. (S2) claimed was unaware of any issues or concerns related to (R1).

The Department reviewed the text communication logs between (S1) and (R1) 's family representative. It was confirmed that (S1) had a text exchange from May 26, 2025, to May 28, 2025. The last recorded text to (S1) by (R1) 's representative was on June 4, 2025, requesting an update. (R1)'s representative has sent an email but has not received a response. Additionally, (R1) 's representative is requesting a callback.

Based on the information gathered, there is sufficient evidence to support the allegation mentioned above.

Allegation #3: Facility staff has not provided a copy of admission agreement to resident's responsible person.

It has been reported that the facility staff did not provide a copy of the admission agreement contract to the responsible person for Resident #1 (R1). Specifically, Staff #1 (S1) has not supplied a copy of the signed admission agreement for (R1) since (R1)’s admission in April 2025.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20250606092721
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: 06/11/2025
NARRATIVE
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A review of Resident #1's (R1) Admissions Agreement, (dated March 19, 2025), shows that (R1)'s representative signed the agreement on that date. However, (R1) did not officially enter Terraza Court Senior Living until April 8, 2025. Additionally, the Agreement contract Appendix A through L records were not signed until April 28, 2025.

On June 11, 2025, between 10:00 AM and 10:15 AM, the Department interviewed resident member identified as Resident #1 (R1). (R1) does not remember the exact date of admission but believes it was in April 2025. (R1) mentioned being present when (R1)'s representative signed the contract documents during the intake process. (R1) stated that (R1) did not receive a copy of the admissions contract, as a family member with power of attorney handles it.

On June 11, 2025, between 10:15 AM and 11:00 AM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). (S1) confirmed to have been responsible staff who process the intake/admission for (R1). (S1) clarified that (R1) and (R1)'s family representative was present during the initial signing of the resident's agreement on March 19, 2025, along with the Community Care Licensing documents. However, (R1) did not officially move into the facility until April 8, 2025, and the remaining sections of the agreement, Appendix A through L, were not signed until April 28, 2025. In admission (S1) acknowledged that (S1) had not provided a copy of the resident's Admissions Agreement to (R1)'s family representative after (R1) signed the records. (S2) stated they were unaware that the Admissions Agreement had not been given to (R1)'s representative.

Based on the information gathered, there is sufficient evidence to support the allegation mentioned above.

Based on observations, interviews, record reviews, and analysis, the preponderance of evidence standard has been met; therefore, the allegations that are determined Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099-D.

An exit interview was conducted, and Executive Director BRITTANY KAVANAUGH was provided with a copy of this report and appeals rights.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20250606092721
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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2025
Section Cited
CCR
87468(a)(b)
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Personal Rights (a) Residents in residential care facilities for the elderly shall have personal rights...(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of:
This requirement is not met as evidence by:
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Licensee will review Title 22 Reg 87468 and submit a copy of the resident's admission agreement to (R1)'s representative. A proof of a receipt must be sent to LPA Dabuet: ernand.dabuet@dss.ca.gov by due date.
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Based on interview and record review, the licensee failed to provide a copy of the signed admission agreement to the resident's representative in a timely manner. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
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Section Cited
CCR
87468.1(a)(9)
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Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9)To have communications to the licensee from their representatives answered promptly and appropriately.
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Licensee will review Title 22 Reg 87468.1 and submit proof of a receipt indicating the the representative was notify and explained the billing error and refund or credit is applied. Proof of correction must be sent to ernand.dabuet@dss.ca.gov by due date.
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This requirement is not met as evidence by:
Based on interview and record review, the licensee failed to communicate with with family representative promptly and appropriately. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20250606092721
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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2025
Section Cited
CCR
87507(B)(4)
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Admission Agreements (B) Rate for additional items and services, including: 4.If the licensee offers additional items and/or services that were not available at the time the admission agreement was signed, a list of these services and charges shall be provided to the resident or the resident’s representative.
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Licensee will review Title 22 Reg 87507 and ahere to the regulations. Licensee will correct overcharge fees/billing error and apply a refund or credit to the resident's account. Proof of correction receipt must be submitted to ernand.dabuet@dss.ca.gov by due date.
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This requirement is not met as evidence by:
Based on record review and interview, licensee failed to provide a list of services/charges to the resident's representative for the overcharge fees for May 2025. This poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6