198602264-12-15-2021-11-AS-MVAO-CCEP4G-20220311095907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 12/15/2021
Date Signed: 12/15/2021 06:27:21 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/19/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211119125809

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	GREG BECKER		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	115	CENSUS: 62	DATE:	12/15/2021
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Galina Tovmasian - Business Office Manager		TIME COMPLETED:	11:58 AM

ALLEGATION(S):

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Facility did not provide a safe environment for resident.
Staff threatened resident.
Illegal eviction.

INVESTIGATION FINDINGS:

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On 11/24/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Executive Director Greg Becker.

On 12/15/2021 Licensing Program Analyst (LPA) Don Senaha conducted a subsequent unannounced complaint visit to this facility and met with Business Office Manager Galina Tovmasian. The purpose of this visit is to deliver the findings of the investigation completed.

The investigation consisted of the following: LPA requested resident roster, staff roster and other service documents on 11/24/2021. LPA conducted interviews with the Administrator, residents (R1-R8), staff (S1-S4) and Witness (W1). Resident (R6) declined to be interviewed. A plant inspection of the facility was conducted on 11/24/2021.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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-20211119125809

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
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 12/15/2021

NARRATIVE

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Allegation: Facility did not provide a safe environment for resident.

It is alleged that the facility did not provide a safe environment for resident. Residents (R2-R5, R7-R8) did not have any concerns regarding the care and supervision being provided to them by the staff. The majority of the residents did not have any concerns regarding any harassment by staff or fellow residents. Staff (S1-S4) stated they have never harassed or seen a resident on resident harassment. Staff (S1) stated there has been a claim by resident (R1) previously that another resident has been harassing her by looking at her. Staff (S1) never witnessed this to be true. Staff (S1) stated she would try to accommodate resident (R1) and move her away from the area if resident (R1) became agitated. LPA obtained training documents regarding the safety for residents.

Based on LPA’s observation, interviews conducted and records reviews, 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 violations did or did not occur, therefore the allegation is Unsubstantiated

Allegation: Staff threatened resident.

It is alleged staff threatened resident. Residents (R2-R5, R7-R8) did not have any concerns regarding the care and supervision being provided to them by the staff. Residents (R2-R5, R7-R8) never felt threatened or harassed by staff. Staff (S1-S4) stated they have never threatened a resident. Staff (S1-S4) stated they have never seen or reported any resident having the door slammed on their hand in the last 6 months. Witness (W1) stated he spoke to resident (R1) and never threatened resident (R1) for not disclosing a name of a potential perpetrator. LPA obtained a letter from attorney’s office that resident (R1) stated she is moving out of facility upon return from the hospital. LPA reviewed previous incident report and no reports of threats to residents.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211119125809

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
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 12/15/2021

NARRATIVE

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Allegation: Illegal eviction.

It is alleged there was an illegal eviction. Residents (R2-R5, R7-R8) stated they have never seen or heard of a resident being evicted from the facility for any reason. Staff (S1-S4) stated they have never seen or heard of a resident being evicted from the facility for any reason. Staff (S1-S3) stated residents are able to come back to their room even after a lengthy hospital stay. Executive Director Becker stated there has been no eviction notices served to any residents from the facility. Executive Director Becker stated the resident’s rooms are always secure and held for the resident if a resident goes out for a hospital stay. Executive Director Becker received an email from Witness (W1) stating resident (R1) “she stated she is moving out of Terraza Court as soon as she returns. She then hung up on me”. Witness (W1) stated the facility never issued an eviction notice. LPA reviewed previous incident reports and no evictions documented.

Based on LPA’s observation, interviews conducted and records reviews, 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 violations did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Business Office Manager Galina Tovmasian and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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