198602264-3-17-2022-11-AS-UCOL-CGQPJX-20220727112217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 01/04/2022
Date Signed: 03/17/2022 05:39:01 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
10/20/2021 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20211020151020

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:	01/04/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Greg Becker		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is hindering residents' complaint investigations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, January 04, 2022. 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 (S1-2) and residents 1-6 (R1-6 LPA Bunker asked questions relevant to the nature of the complaint. Executive Director Greg Becker stated the facility is not hindering residents' complaint investigations. Mr. Becker stated that he provided Ombudsman Representative Anita Lee-Smith with the documents she requested. On 10/06/2021 the documents she requested were available for pick-up and she never picked them up. Mr. Becker stated on 10/13/2021 he emailed Anita a confirmation letter to her concerning regarding the facility infection control and care plan.
See continued LIC9099-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: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

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 3

Control Number 11-AS-20211020151020

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: 01/04/2022

NARRATIVE

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Continued LIC9099-C page 2

Mr. Becker stated Ombudsman Representative Ms. Smith personally provided him with a copy of the State of California "Notice To Long-Term Care Facilities Regarding Ombudsman Access To Facilities, Residents and Records", and he refused to sign. Mr. Becker stated Ms. Smith emailed him the same notice. Mr. Becker stated he doesn't remember the exact dates and times. Business Manager Galina Tovmasia stated she also refused to sign the same documents. Staff stated Ombudsman Representative has access to the facility and residents' records, they are an advocate for the residents, and the facility staff does not interfere with their investigations. Some documents require a consent form to release documents due to the HIPAA law. Some of the resident's families request the facility not to release confidential documents until they provide permission and consent to do so. Mr. Becker stated the Ombudsman Representative provided him with a copy of the documents and he refused to sign. However, he did take the documents and had their legal department review the documents.

Allegation #1: The facility is hindering residents' complaint investigations
Staff 1-2 (S1-2) interviewed stated the facility staff is not hindering residents' complaint investigations. They have provided the Ombudsman Representative Anita Lee-Smith with will all the documents she requested. Mr. Becker stated all the other employees that Ms. Smith contacted are no longer employed. Staff denied the allegation.

Investigation revealed the following: Interviews were conducted with staff 1-2 (S1-2) and residents 1-6 (R1-6), all stated the facility staff is not hindering residents' complaint investigations. Executive Director Greg Becker stated that he provided Ombudsman Representative Anita Lee-Smith with the documents she requested, and he also emailed Anita to let her know the documents she requested were available for pick-up and she never picked them up. Mr. Becker stated Ombudsman Representative has access to the facility and residents' records, they are an advocate for the residents, and the facility staff does not interfere with their investigations. Staff stated they report all incidents to the appropriate agencies in a timely manner according to Title 22 Regulations. Staff denied the allegation.

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: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211020151020

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: 01/04/2022

NARRATIVE

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Continued LIC9099-C page 3

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: 01/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022

LIC9099 (FAS) - (06/04)

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