198320478-2-19-2025-11-AS-UCOL-DEEVRY-20250303154042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320478
Report Date: 02/19/2025
Date Signed: 02/19/2025 04:40:21 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
02/12/2025 and conducted by Evaluator Regina Cloyd

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250212123219

FACILITY NAME:	AVOCET AT PLAYA VISTA		FACILITY NUMBER:	198320478
ADMINISTRATOR:	MCGEVNA, KEITH M		FACILITY TYPE:	741
ADDRESS:	12490 FIELDING CIRCLE		TELEPHONE:	(424) 216-7788
CITY:	PLAYA VISTA	STATE: CA	ZIP CODE:	90094
CAPACITY:	286	CENSUS: 213	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Executive Director Keith McGevna		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Questionable Death.
Facility staff failed to seek timely medical attention.

INVESTIGATION FINDINGS:

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The investigation consisted of the following:

On 02/19/2025, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegations. CCLD Staff met with Executive Director Keith McGevna and explained the purpose of the visit. CCLD Staff reviewed Department, facility, and resident records, interviewed staff and residents, and toured parts of the facility relevant to the allegations.

Allegation:
Regarding the allegation "Questionable Death,” it is being alleged that Resident #1 (R1) passed away at the facility due to choking. R1’s physician’s report (dated 08/2023) revealed that R1 was not on a special diet and R1 was able to feed self. Department records indicated that R1 had a private caregiver (W1) who is employed by an outside home care organization. W1 was present during the incident.
Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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 3

Control Number 11-AS-20250212123219

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: AVOCET AT PLAYA VISTA	FACILITY NUMBER: 198320478
	VISIT DATE: 02/19/2025

NARRATIVE

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Records also indicate that W1 observed R1 lean back in R1’s room chair after dinner and W1 began to prepare dessert in the kitchen. When W1 returned to R1’s room, W1 noticed R1 was pale and unresponsive. W1 made a phone call, pressed the call button, received a call, and then called 911. Interview with the facility’s nurse (S2) indicated that S2 assessed the situation, placed R1 on the floor, and started performing CPR until the paramedics arrived. The death report revealed the following: R1 passed away on 01/09/25 7:01 PM in R1’s apartment; Paramedics determined airway obstruction – food blockage – was the immediate cause of death; At 6:22 PM, R1 was assisted to lying position, CPR initiated, law enforcement contacted, and staff remained with resident; Paramedics and police arrived and called time of death at 7:01 PM.

Regarding the allegation “Questionable Death," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation: "Facility staff failed to seek timely medical attention,” for Resident #1 (R1).

Department records indicated that R1 had a private caregiver (W1) who is employed by an outside home care organization. W1 was present during the incident. Records also indicate that W1 noticed R1 was pale and unresponsive. W1 called Witness #2 for guidance, pressed the facility’s call button several times, received a call from Witness #3, and then called 911. Department records also indicated that W1 pressed all three buttons. LPA observed that the call system in residents’ room include three buttons. Interview with the Executive Director (S1) and staff indicated that one of the three buttons is selected to clear the call. Interview with the facility’s nurse (S2) indicated that R1’s family called the lobby and the message was relayed to nursing station. S2 indicated that upon arrival to R1’s room, S2 assessed the situation and performed CPR until the paramedics arrived. Five out of six resident interviews indicated that staff provides timely medical attention. Five out of six staff interviews indicated that staff responds to a call button within five to ten minutes.

Continue to LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250212123219

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: AVOCET AT PLAYA VISTA	FACILITY NUMBER: 198320478
	VISIT DATE: 02/19/2025

NARRATIVE

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Regarding the allegation “Facility staff failed to seek timely medical attention,” based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Executive Director Keith McGenva.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

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