198602264-3-20-2022-11-AS-MVAO-CCTUK7-20220324153841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 12/29/2021
Date Signed: 03/20/2022 03:22:47 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
10/06/2021 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20211006133847

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: 65	DATE:	12/29/2021
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Greg Becker		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident has scabies
Staff did not fulfill their reporting requirements
Resident is isolated to his room
Resident is unkept
Staff did not safeguard resident's personal items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, December 29, 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 1-4 (S1-4) and residents 1-7 (R1-7). LPA Bunker asked questions relevant to the nature of the complaint.

See continued LIC8123-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: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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 4

Control Number 11-AS-20211006133847

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: 12/29/2021

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Resident has scabies
Interviews with staff 1-4 (S1-4) and residents 2-7 (R2-7) all stated they were not aware of any residents with scabies. Staff 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. R1 was itching and scratching his arm. Med Tech called R1's daughter immediately and informed the facility nurse Brooke Lumotte. The Med Tech suggested R1's daughter contact R1's Primary Care Physician and schedule a medical appointment. The daughter stated the appointment was too far away and scheduled a telehealth appointment for 09/23/2021. The daughter took photos of the rash so the doctor can observe the rash. R1 had not seen a dermatologist to have his skin scrapped for scabies. The daughter told the doctor R1 had scabies. R1 was prescribed Permethrin 5% and staff applied ointment according to the doctor's order. On 09/29/2021 R1's rash and skin were red. Med Tech continued to apply ointment per doctor's orders. R1 was put on temporary precaution isolation until he was cleared from isolation by his doctor.

Allegation #2: Staff did not fulfill their reporting requirements
Interviews with staff 1-4 (S1-4) stated they are fulfilling the reporting requirements according to the regulations. Staff stated they report all incidents to the resident's family, responsible party, Community Care Licensing, and all appropriate agencies. Residents 2-7 (R2-7) stated staff reports incidents concerning them to their family members immediately.

Allegation #3: Resident is isolated to his room
Interviews with staff 1-4 (S1-4). Staff stated they are following the physicians' orders and public health guidelines. Staff stated on 10/26/2021 R1 was on temporary precaution 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 self-reported to all the appropriate agencies in a timely manner. Staff stated R1's daughter would pick R1 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 the facility has to take the necessary safety precautions.

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: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20211006133847

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: 12/29/2021

NARRATIVE

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Continued LIC812-C page 3

Allegation #3: Resident is isolated to his room
Staff stated R1's 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, they monitor all their residents to prevent an incident like this from occurring. The facility staff is following Community Care Licensing, CDC, and Public Health guidelines. 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. Residents 2-7 (R2-7) stated they haven't witnessed any residents isolated in their rooms or treated for scabies.

Allegation #4: Resident is unkempt
Interviews with staff 1-4 (S1-4) and residents 2-7 (R2-7) all stated residents are not unkempt. Residents have a shower schedule and laundry days and their clothes and bedding are cleaned. During today's visit, LPA Bunker observed the residents they were well-groomed.

Allegation #5: Staff did not safeguard the resident's personal items
Interviews with staff 1-4 (S1-4) stated no one is taking residents' personal items. Staff stated they are very careful not to mix up residents' laundry. Residents 2-7 (R2-7) all stated residents' personal belongings are safeguarded and they had no probably with anyone removing their personal items. Staff stated they are very careful not to mix up residents' laundry. Staff and residents stated staff is not mixing dirty clothes with clean clothing.

Investigation revealed the following Interviews were conducted with staff 1- 4 (S1-4), and residents 2-7 (R2-7), all 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. Staff immediately notified R1's daughter and R1's Primary Care Physician. R1 had a telehealth appointment for 09/23/2021. The daughter send the doctor photos and said it was scabies, without a scrapping from the dermatologist. R1 was prescribed Permethrin 5% and staff applied ointment according to the doctor's order.

See continued LIC9099-C page 4

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20211006133847

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: 12/29/2021

NARRATIVE

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Continued LIC812-C page 4

The daughter send R1's doctor photos of the rash and she said it was scabies. R1 had not seen a dermatologist to have his skin scrapped for scabies. R1 was prescribed Permethrin 5% and staff applied ointment according to the doctor's orders. On 09/29/2021 R1's rash and skin were red. Med Tech continued to apply ointment per the physician's directions. R1 was put on temporary precaution isolation per the doctor's orders. R1 was released from isolation once he was cleared by his physician. Staff self-reported the incident and are following Title 22 Regulations requirements. Residents were observed to be well-groomed. Staff and residents stated resident's personal items are safeguarded. Staff denied allegations.

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.

A copy of the Complaint Investigation Report LIC 9099, LIC9099-Cs, and Confidential Names LIC 811 was provided to Executive Director Greg Becker.

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: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4