198602264-7-2-2020-11-AS-MVAO-BRBREB-20200708125715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 07/02/2020
Date Signed: 07/02/2020 12:07:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2020 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200619155629

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	ZAMUDIO, JESSE		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	115	CENSUS: 67	DATE:	07/02/2020
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Pamela Junge-Facility Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident toilet is leaking.
Sewage is leaking into the dry food storage in the kitchen.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Pamela Junge, the facilities Executive director.

The investigation consisted of the following:
On 6/24/2020 LPA Cifuentes conducted initial 10-day televisit and met with Administrator Pamela Junge and maintenance director Hector Nieves. During the call, LPA Cifuentes spoke with administrator, maintenance director and was shown kitchen, as well as resident bedrooms by maintenance director Nieves. On 6/25/2020 and 6/30/2020 LPA conducted interviews with staff 1-6 as well as residents 1 through resident 8. LPA requested and received the following documents: facility work orders for maintenance, plumbers’ receipts and receipts for parts used in repairs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2020

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-20200619155629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 07/02/2020

NARRATIVE

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The investigation revealed the following:

On 6/24/2020 LPA toured facility. LPA was shown four client rooms and attached bathrooms. No leaks were noted from toilet by LPA or maintenance.

On 7/2/2020 LPA reviewed facility work orders and plumbers’ bills. Both the plumbers bills and work orders show that issues like clogged toilets, water damage, or fixing of doors are handled in a timely manner.

On 6/25/2020 and 6/30/2020 LPA Cifuentes interviewed residents 1-8. Of the resident’s interviewed, 1 did not reply, but 7 out of 7 stated their toilets were not leaking and that they had not needed maintenance on their rooms.

On 6/25/2020 and 6/20/2020 LPA Cifuentes interviewed facility staff. Out of 7 staff asked, two did not know anything about facilities toilets, out of the 5 remaining, 5 out of 5 staff stated that clients toilets were not leaking.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Sewage is leaking into the dry food storage in the kitchen

The investigation revealed the following:

On 6/24/2020 LPA Cifuentes was given a tour of facility. Tour began in kitchen, where LPA was shown dry storage room. Due to using video chat, LPA was not able to see a leak in celling, but per staff member giving tour, it did in fact have a leak and there were buckets to catch the runoff. Ceiling appeared to be intact, not buckling or appearing to cave in. Continued on LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200619155629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 07/02/2020

NARRATIVE

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There was a minimal number of items in the room and they had all been pushed to one side. LPA was told plumbers had been called in April to fix leak, which appeared to be repaired but had recently started to leak again. As leak was thought to possible be coming from resident rooms above dry storage area LPA was shown the four client rooms and attached bathrooms above dry storage on both second and third floors. No leaks were seen coming from the toilets or sinks although one room, 138 had a water spot on the wall next to the shower. Per staff, this room was remodeled, the room on the other side, with the bathroom on the same wall has no water marks on the wall. LPA was informed that a plumber had already been called on 6/23/2020 to further investigate where the leak was coming from and to fix it.

0n 6/30/2020 LPA Cifuentes reviewed plumbers’ invoice from 4/17/2020. Invoice outlines work completed in kitchen in April to fix wall. The work order dated 6/23/2020 outlines a water leak believed to be going from third floor down to the second floor and through to the kitchen’s dry storage area. Notes say it was found by plumber to be an AC drip line and that facility staff repaired it on 6/25/2020. A receipt for parts was submitted to LPA.

On 6/25/2020 and 6/20/2020 LPA Cifuentes interviewed seven facility staff. Of the 7 staff interviewed, 4 confirmed they had seen a leak in kitchen. Of those interviewed, two stated the water did not smell of sewage.

Exit interview conducted, and a copy of the report was emailed to Pamela Junge, executive director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2020

LIC9099 (FAS) - (06/04)

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