198602264-7-6-2020-11-AS-MVAO-BRBTJH-20200708144621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 05/01/2020
Date Signed: 07/06/2020 02:07:32 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
04/03/2020 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20200403102723

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: 75	DATE:	05/01/2020
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Pamela Junge		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not safeguarding residents personal property
Staff are not providing adequate food service
Staff did not refill resident's medication
Staff are not responding to resident's call button in a timely manner

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 4/13/2020 LPA Cifuentes conducted initial 10-day televisit and met with Administrator Pamela Junge. During the call, LPA Cifuentes spoke with administrator, was shown dining room, kitchen, as well as resident bedrooms. LPA requested that pull cord be pulled in one room to test response time, which was two minutes. On 5/1/2020 LPA conducted telephone interviews with staff and residents. LPA requested and received the following documents: copy of R1's Admissions Agreement, inventory sheet and medication logs be sent via fax to CCL.

Regarding the allegation: Staff are not safeguarding resident’s personal property

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: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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 4

Control Number 11-AS-20200403102723

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: 05/01/2020

NARRATIVE

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The investigation revealed the following:

On 4/13/2020 LPA toured facility. LPA saw dining room, activity room, kitchen and a few resident bedrooms.

On 4/28/2020 LPA reviewed facility files. Per admissions agreement section 35. Theft and Loss/Damage to property: “The community is not an insurer of the Resident’s person or possessions…The resident agrees that all of the Residents Personal Property kept or located within the Apartment or elsewhere in the Community or grounds shall be kept at the risk of the Resident only.” Residents are provided with an inventory sheet to document items they are bringing in, but one was not available for R1 as they have not filled it out.

On 5/1/2020 LPA interviewed residents 1-7. Of the resident’s interview 5 out of 7 stated they had not had any belongings stolen.

On 5/1/2020 LPA Cifuentes interviewed facility staff. 4 out of 5 staff stated that they had not heard or been told of any clients having their items stolen.

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: Staff are not providing adequate food service

On 4/13/2020 LPA toured facility. LPA saw dining room, activity room, kitchen and a few resident bedrooms.

On 4/28/2020 LPA reviewed facility files. Per admissions agreement section 17 part B. Dining: The community will provide three (3) meals daily and in between snacks as part of the Basic Monthly Fee. The three daily meals will be served restaurant style to the Residents Table.”

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20200403102723

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: 05/01/2020

NARRATIVE

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On 5/1/2020 LPA interviewed residents 1-7. Of the resident’s interview 5 out of 7 stated food was good and served at the correct temperature.

On 5/1/2020 LPA Cifuentes interviewed facility staff. 4 out of 5 staff stated food was served to residents at correct temperature and that there was a variety of items. Staff stated they did not know if the food was good.

Regarding the allegation: Staff did not refill resident’s medication

On 4/13/2020 LPA toured facility. LPA saw dining room, activity room, kitchen and a few resident bedrooms.

On 4/28/2020 LPA reviewed facility files and spoke with facility administrator. Per Director Junge some residents handle their own medication fills, refills and administration and some residents have their refills, fills and administration handled by the facilities staff. Director Junge also informed LPA that R1 changed insurance late last year and their new insurance plan did not include medications. As pharmacy was not being paid they refused to send medications at one point. This situation has since been resolved.

On 5/1/2020 LPA interviewed residents 1-7. Of the resident’s interview 3 out of 7 stated facility staff handle their medications and they had no issues receiving them timely, 3 out of 7 handled their own medications or did not know how they got their medications.

On 5/1/2020 LPA Cifuentes interviewed facility staff. 3 out of 5 staff stated the med tech handled medication fills, refills and administration for the clients.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200403102723

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: 05/01/2020

NARRATIVE

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On 4/13/2020 LPA toured facility. LPA saw dining room, activity room, kitchen and a few resident bedrooms. LPA requested that Director Junge pull emergency pull cord in rooms. Response time was roughly 2 minutes. Per caregiver staff, they all carry pagers and radios. Pull system is connected to a pager that alerts all caregivers of room number that is requesting assistance. Responding caregiver will radio that they are assisting. If no one radio’s in reception pages staff to let them know clients continues to need assistance.

On 5/1/2020 LPA interviewed residents 1-7. Of the resident’s interview 5 out of 7 stated they had not had any never used pull cord so were unable to say whether system worked or what the response time was.

On 5/1/2020 LPA Cifuentes interviewed facility staff. 4 out of 5 staff stated that response time was a few minutes. LPA was also informed that manager checks that pull cord system is working constantly and that if system is not working caregivers conduct checks every 30 minutes on clients.

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: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC9099 (FAS) - (06/04)

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