198602264-11-12-2021-11-AS-MVAO-CCTU5M-20220324151657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 11/12/2021
Date Signed: 11/12/2021 11:19:08 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
11/04/2021 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211104095605

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: 63	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Greg Becker		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff have not taken resident out of isolation after treatment for scabies.
Staff are not adhering to California Department of Public Health guidelines.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Friday, November 10, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Executive Director Mr. Greg Becker. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-2 (S1-2) and residents 2-5 (R-5). LPA Bunker requested and reviewed R1's records. Mr. Becker stated the facility followed resident 1 (R1) doctor's recommendation to isolate R1. R1 was taken off of isolation after treatment was completed. Staff stated they are adhering to California Department of Public Health guidelines. Mr. Becker stated the Health Department stated it is only an outbreak if three (3) or more residents were infected. LPA Bunker requested copies of R1's Records, SIR, Physicians Report, Medical Administration Record, Resident Roster, Special Incident Reports, Email from the Public Health Nurse, and Narrative Charting.
See Continued LIC812-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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-20211104095605

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: 11/12/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC9099-C page 2

Allegation: #1 Staff have not taken resident out of isolation after treatment for scabies.
Investigation revealed the following: Staff 1-2 (S1-2) and residents 2-5 (R2-5) were interviewed and stated that none of the other residents have scabies at Terraza Court. Med Tech Amber Hart stated on 09/19/2021 R1 had a rash, on both arms, and R1 was itching and scratching his arm. Med Tech called R1's daughter immediately and informed the facility nurse Brooke Lumotte, and she contacted R1's Primary Care Physician. The daughter stated the appointment was too far away and scheduled a telehealth appointment for 09/23/2021. R1 was prescribed Permethrin 5% and staff applied ointment according to the doctor's order. On 09/29/2021 R1 rash and skin was red. Med Tech continued to apply ointment per doctor's orders. On 09/30/201 R1 was put on temporary precaution isolation.

Staff stated on 10/26/2021 R1 was isolated according to his physician's directions. Once the doctor said to release R1 from isolation staff stated they followed the doctor's order and released R1 from isolation.
Mr. Becker stated this incident was reported to all the appropriate agencies in a timely manner. Staff stated R1's daughter would pick him up almost every day and take him out in the community, to his medical appointments, lunch, dinner, etc. Staff stated she would bring in all kinds of personal items for R1. Staff told the daughter she need to check those items in before bringing them up to R1's room due to COVID-19 they are taking the necessary safety precautions. Staff stated R1 daughter would take his bedding with her and wash them, and bring them back to the facility. Staff stated housekeeping cleans all the resident's beddings. Staff stated they monitor all their residents to prevent an incident like this from occurring. They are following CDC and Public Health guidelines. Staff stated they don't know where R1 got scabies since none of the other residents was diagnosed with scabies. Staff stated they had no control over where the daughter would take R1. They do not believe R1 contracted scabies at the facility he made have gotten it out in the public with his daughter. Staff denies R1 got scabies at Terraza Court and R1 is no longer isolated.

See Continued LIC9099-C page 3

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211104095605

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: 11/12/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued LIC812-C page 3

Allegation #2 Staff are not adhering to California Department of Public Health guidelines.
Investigation revealed the following: Mr. Becker and Med Tech Amber Hart stated the facility is adhering to all of CDC and California Department Public Health guidelines. Mr. Becker provided an email dated 10/13/2021 from Public Health Nurse that stated one resident does not warrant an outbreak at a facility for scabies. Staff stated the allegation is false and denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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, therefore the allegation is deemed unsubstantiated.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3