198602264-3-14-2022-11-AS-AJKK-CDJ2AY-20220415171419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 03/14/2022
Date Signed: 03/14/2022 02:42:22 PM

Unsubstantiated

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
11/16/2021 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211116153747

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: 64	DATE:	03/14/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Greg Becker		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Residents call buttons are not being answered timely due to insufficient staffing
Residents are not being showered timely due to insufficient staffing
Residents are not changed timely
Residents are not being taken down to the dining-room
Residents rooms are not being cleaned timely
Medications were acessable to resident
Staff are not ensuring residents are taking medications
Staff are rough with residents

INVESTIGATION FINDINGS:

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On 03/14/2022 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA Agard was met with Business Office Manager, Galina Tovmasima and explained the purpose of the visit was to gather information regarding this complaint.

The investigation consisted of the following: On 11/22/2021, LPA conducted a 10-day visit and met with Galina Tovmasima. LPA toured the facility and completed interviews and requested copies of facility records. On 03/09/2022 LPA conducted additional interviews.

On 03/14/2022, LPA Agard delivered findings.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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Regarding the allegation: Residents call buttons are not being answered timely due to insufficient staffing. It’s being alleged the resident and several other residents are not getting their call buttons answered timely due to the facility not having enough staff. The investigation revealed the following: During interviews with staff, 1 of 5 confirmed the allegation to be true, 3 of 5 confirmed the allegation to be false and 1 of 5 could not confirm or deny. S1 states, “We had appropriate staffing including a supplement staffing agency.” S2, S3, S4, generally stated the allegation was not true. “It’s not true. We respond as soon as we see the button. We page their caregiver, but it is possible that their caregiver is busy, and we tell the residents that they caregiver will be with them in a moment.” “When I’m here I try to make sure my staff answer in a timely manner.” S5 states, “Yes, sometimes they are not answered right away. Some of the residents like to have their service fast. We have to take care of the residents in order. I’ve had residents complain that I was late.”

During interviews with the residents, 1 of 6 confirmed the allegation to be true, 1 of 6 confirmed the allegation to be false, 2 of 6 could not confirm or deny and 2 were unable to interview. R1 and R2 generally could not confirm the allegation to be true or false. Both states, “I don’t use my call button.” R3 states, “I have used it one time and it wasn’t answered. I waited like 40 mins, so I went down. I’ve used it 3 or 4 times and they had not responded a couple times. This happened at night both times.” R4 states, “I don’t call much, but the times I have, they have come.” R5 was unable to interview and R6 was unable to interview due to cognitive impairment.”

During interviews with witnesses all 3 were unable to confirm the allegation to be true. “I can’t speak on that.”

Regarding the allegation: Residents are not being showered timely due to insufficient staffing. It’s being alleged a resident and several other residents are not getting showers on time due to the facility not having enough staff. The investigation revealed the following: During interviews with staff 0 of 5 confirmed the allegation to be true, 3 of 5 confirmed the allegation to be false and 2 of 5 could not confirm or deny. S1 states, “The only thing I can speak on that is I can provide you with a showering schedule and have you speak with the staff.” S2 states, not being sure. S3 and S4 denied the allegation to be true. “That’s not true either. We have shower list and we go by the day and the showers. From what I know everyone was getting showered. Each resident has a day for their shower.”
Cont. on 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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During interviews with the residents, 0 of 6 confirmed the allegation to be true, 1 of 6 confirmed the allegation to be false, 3 of 6 could not confirm or deny and 2 were unable to interview. R1, R3 and R4 all state not being sure. R1 states, “I have never heard anyone complaint that they didn’t get a shower.” R3 states, “I don’t require support with showering. I haven’t witness or heard anything regarding that.” R2 confirmed the allegation to be generally false. “I don’t require support with showers. I can hear the caregivers stating they are going to give showers to residents, and I see them following through. I haven’t heard any complaints.” R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses. 1 of 3 confirmed the allegation to be true, W3 states, “Yes, I had experience with that. No one is taking time with showering my relative. Their skin is so dry sometimes. I don’t know that anyone has been assisting them with that. I told the supervisor of memory care, but there is so much turnover.” W1 & W2 both are unable to confirm the allegation to be true.

Regarding the allegation: Residents are not changed timely. It’s being alleged residents are not being changed. The investigation revealed the following: During interviews with staff 0 of 5 confirmed the allegation to be true, 5 of 5 confirmed the allegation to be false. S1- S5 all denied the allegation to be true. S1 states, “That’s being done.” S2 states, “I’m not sure what is meant by timely. For the residents that don’t need assistance we don’t help them. When there is a resident that needs to be changed or assistance with changing, the staff will help. If the person is bed bound the staff check every 2 hours. Residents are not walking soaking wet and not getting changed.” S4 states, “We check on them every 2 hours and change them. I change them 3 times in the morning.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true or false, 4 of 6 could not confirm or deny and 2 were unable to interview. R1- R4 were all unable to verify the allegation to be true or false. R1 & R4 states, “I have never heard of that either. R2 states, “I’m not sure about that and I don’t require support.” R3 states, “I don’t know about that.” R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses: 1 of 3 confirmed the allegation to be true. W3 states, “Yes, I will go in there and on more than two occasions my relative had on the exact same clothing they had on a week earlier.” W1 cont. 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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& W2 both are unable to confirm the allegation to be true. W1 states, “That’s going to be the same answer. (I don’t know about that). It’s hard for things to be kept track of. Clothing moves around a lot due to the residents in memory care.” W2 states, “I don’t know about that.”

Regarding the allegation: Residents are not being taken down to the dining-room. It’s being alleged the staff refused to take the residents down to the dining-room for lunch. Other residents are also not being taken to the dining-room. The investigation revealed the following: During interviews with staff 0 of 5 confirmed the allegation to be true, 5 of 5 confirmed the allegation to be false. S1-S5 all state around the time of the complaint the dining room was closed as a precautionary measure. S1 states, “The dining room was closed due to covid. Food was being delivered to their room. S2 states, “the dining room was shut down due to covid. So, the meals were being brought to them. Once the dining room opened then they were allowed back down. S3 states, “Dining was closed. Everyone was isolated to their rooms.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true, 3 of 6 confirmed the allegation to be false, 1 of 6 could not confirm or deny and 2 were unable to interview. R1 states, “The dining room was not open in November. They were bringing the food to us.” R2 states, “I don’t remember exact dates but during that time they were serving us in our rooms at that time. We were on lock down and we were being served in our rooms.” R3 states, “Yes, it was closed up on November 17^th. We had been served in our room due to being on lock down.” R4 states, I don’t recall.” R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses: 0 of 3 confirmed the allegation to be true. W1-3 all confirm the allegation to be false. W1 states, “My understanding was food was going to the room due to the dining room being closed. Covid was so out of control then. They had to shut down the dining room. I felt like they handled it very well. W2 states, “I know that during covid, they were quarantine to their room and food was being brought to their rooms.” W3 states, “They informed us they were closing the dining room due to Covid.”

Regarding the allegation: Residents rooms are not being cleaned timely. It’s being alleged a resident and several other residents are not getting their rooms cleaned. The investigation revealed the following: During interviews with staff 0 of 5 confirmed the allegation to be true, 5 of 5 confirmed the allegation to be false. S1 states, “That’s a duplicate complaint. Back then, it was being done once per week or as needed.” S2 states,
Cont. 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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“We have a schedule for them they are cleaned once per week and as needed by the caregiver. Garbage is taken out every day.” S3 states, “We have had more housekeepers in November, there were 2. Everyone’s room were clean. Housekeeping has a set number of rooms they clean on a specific day. If we see it’s dirty, we help out. The housekeeper does a deep cleaning and we maintain it.” S4 states, “That’s not true. If I see a room dirty, we have to clean it. If I see something, I usually clean it up.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true, 4 of 6 confirmed the allegation to be false, and 2 were unable to interview. R1 states, “yes, the housekeeper always cleaned back then.” R2 & R3 state, “when the former housekeeper was around, it was good. She did a good job and was timely. R4 states, “yes, the rooms were being cleaned. R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses: 1 of 3 confirmed the allegation to be true, 1 of 3 confirmed the allegation to be false and 1 of 3 was unable to confirm or deny the allegation to be true. W3 states, “yes, I found that to be true. I often clean up when I go there. Clothes are not being washed. sheets are not being cleaned. I have to bring it to their attention.” W2 states, “generally, yes.” W1 states, “I rarely go in their room. We are mostly in the common area. I haven’t taken a look in their room. I don’t want to invade the roommate’s privacy. The common areas are clean.”

Regarding the allegation: Medications were accessible to resident. It’s being alleged a "hypodermic needle" was left on the roommate’s nightstand. The investigation revealed the following: During interviews with staff 0 of 5 confirmed the allegation to be true, 5 of 5 confirmed the allegation to be false. S1 states, “No, we have a resident that is diabetic. None of the families complained that a needle was left out. For R5, we control their diabetic meds in the med cart.” S2 states, “That’s for sure not true unless the person is taking their own medication who is doing it on their own. The meds are kept in a med cart and its locked and never unsupervised.” S3 states, “not on my watch. They inject themselves. I set it and they give it to themselves. I put it back in the cart.” S5 states, “I never witnessed a needle out.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true, 3 of 6 confirmed the allegation to be false, 1 of 6 could not confirm or deny the allegation, and 2 were unable to interview. R1, R3, and R4 all state, not witnessing any needles being left out. R2 was unable to confirmed due to visual
Cont. 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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impairment. R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses: 0 of 3 confirmed the allegation to be true. W1-3 all state they have never witnessed the allegation. W1 & W2 both states, “I have not seen that.” W3 states, “No, I have not.”

Regarding the allegation: Staff are not ensuring residents are taking medications. It’s being alleged the staff give out medications, they just set the medications in front of residents and then walk away not checking to see if the resident took the medication. The investigation revealed the following: During interviews with staff, 1 of 5 confirmed the allegation to be true, 4 of 5 confirmed the allegation to be false. S1 states, “Not true.” S2 states, “staff do, they wait for the resident to take a med. They need to make sure they take it because if the resident refuse, they need to report that to their doctor.” S3 states, “Not me. I make sure to pour the meds and that they take it in front of me. Residents can forget to take them and leave them on the table, so I have to make sure they take them.” S5 states, “I have witness staff leaving the medicine out for the residents that are more independent. I’ve seen med residue left on the tables. It’s left out and residents take it on their own time.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true, 3 of 6 confirmed the allegation to be false, 1 of 6 could not confirm or deny the allegation, and 2 were unable to interview. R1 states, “no, I have not witnessed staff leaving medication out. R3 states, “yes, the staff waits for me to take it.” R4 states, “they watch me take it.” R2 states, “I take my own medication so I couldn’t really say. R5 was unable to interview and R6 was unable to interview due to cognitive impairment.

During interviews with witnesses: 0 of 3 confirmed the allegation to be true. W1 states, “I have not witness or experience that in 10 years.” W2 & W3 both states, “No, never seen that.”

Regarding the allegation: Staff are rough with residents. It’s being alleged staff members are very rough with the residents. A staff "threw" a resident’s leg in a wheelchair. Staff have been observed being rough with other residents. The investigation revealed the following: During interviews with staff, 1 of 5 confirmed the allegation to be true, 4 of 5 confirmed the allegation to be false. S1 states, “None that I’m aware of. I’ve never had any reports of that.”
S2 states, “I haven’t heard anything about that otherwise they would be terminated or suspended. There
Cont. 9099C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 11-AS-20211116153747

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: 03/14/2022

NARRATIVE

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wasn’t even one allegation.” S3 and S4 both states, “No.” S5 states, “I have been rough with a resident once, but I did not mean to be. They screamed ouch. I took responsibility for that.”

During interviews with the residents: 0 of 6 confirmed the allegation to be true, 4 of 6 confirmed the allegation to be false, and 2 were unable to interview. R1 states, “No, I have never witness staff being rough with residents. They are nice to me.” R2 states, “no, I haven’t seen that at all. R3 states, “no, never observed or been a victim. R4 states, “no, they have never been rough.”

During interviews with witnesses: 0 of 3 confirmed the allegation to be true. W1 states, “I have never seen that, never, never. I can say people generally care about my relative there.” W2 states, “no, never seen or heard and my relative has never complained. W3 states, “no, never witness that.”

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegation(s) 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 unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

Page: 7 of 7