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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:42:17 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
06/07/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220607112209
FACILITY NAME:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Stephanie Funderburg, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident sustained injury while in care
Staff are not responding to resident's call buttons in a timely manner
Staff did not administer resident's medication in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Stephanie Funderburg, Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 06/14/22, LPA Soto interviewed Greg Becker, Executive Director, R#1 – R#6. On 08/29/2022, LPA Soto interviewed S#2 – S#6. LPA Soto received the following documents on 06/14/22 for R#1 & R#2: Face sheets, Pre-Appraisals, Physician's Report, Admissions agreement, Med Tech procedures on distributing medications, and Incident Reports.

Based on the LPA's investigation, the investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
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 6
Control Number 11-AS-20220607112209
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: 10/21/2022
NARRATIVE
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Allegation 1 – Resident sustained injury while in care. R#1 states that they fell while taking a walk through the hallways. R#1 was using a walker and tripped on the carpet and fell. R#1 sustained bruising and swelling from the fall. When the incident occurred, R#1 got up and went straight to their room. They did not report the incident to the staff, R#1 just informed R#1 family member. Interviews with R#2 – R#6, stated that they have never had any injuries while at the facility. Interviews with Staff and executive Director stated that they did not receive any reports of residents getting injured while in care. LPA observed R#1 injury on their right knee, it was still a little bruised, it was already healing. Even though, R#1 did fall, R#1 is able to walk without care giver assistance, therefore, the facility could not have prevented the accidental fall. The interviews and observations did not concur with the above allegation.

Allegation 2 - Staff are not responding to resident's call buttons in a timely manner. Interviews with staff Executive director, they all agree that the call buttons are always answered right away. If they cannot answer the call button right away because they are busy taking care of another resident, they call another care giver for help. Resident interviews all agree that some staff do not respond in a timely manner they take about 20 to 30 mins to respond to the call button. LPA and Executive Director tested the call button on room 214, it took the care giver 10min. to answer the call button. Executive director stated that it should take a care giver 5min to 10min depending on what the care giver is doing at the time. The interviews and observations did not concur with the above allegation.

Allegation 3 - Staff did not administer resident's medication in a timely manner. Interview with R#1 stated that they asked for medication for headache and it never arrived. R#1 let her family member know and they texted care giver requesting medication. Medication was delivered about 25 min after text request and family member had to look for care giver. R#2, R#5, & R#6 agreed that staff is always late with their medication. R#3 & R#4, cannot recall if their medication is on time or not. Executive Director and S#2 – S#6, all agreed that they always give medication on time. LPA reviewed the Medication Procedures. Med 02 - Section, allows Medication technicians to give medication 1 hour before or 1 hour after the prescription time, unless actual time stated by doctor. The interviews and records reviewed did not concur with the above allegation.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20220607112209
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: 10/21/2022
NARRATIVE
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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 unsubstantiated.

An exit interview was conducted with Stephanie Funderburg, Executive Director, and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6
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
06/07/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220607112209

FACILITY NAME:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Stephanie Funderburg, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are rude.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Stephanie Funderburg, Executive Director

The investigation consisted of following: Interviews and Record reviews. On 06/14/22, LPA Soto interviewed Greg Becker, Executive Director, R#1 – R#6. On 08/29/2022, LPA Soto interviewed S#2 – S#6. LPA Soto received the following documents on 06/14/22 for R#1 & R#2: Face sheets, Pre-Appraisals, Physician's Report, Admissions agreement, Med Tech procedures on distributing medications, and Incident Reports.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20220607112209
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: 10/21/2022
NARRATIVE
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Based on the LPA's investigation, the investigation revealed the following:

Allegation 1 - Staff are rude. Interviews with Staff and Executive director, all agree they are never rude to any residents. They are always nice to all the residents. Interviews with R#1, R#2, R#3, R#5, and R#6 all agree that staff are very rude all the time. R#4 stated that staff is not rude, they are nice to R#4. Residents had specific staff that are rude and mistreat them. Interviews conducted did concur with the above allegation.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

An exit interview was conducted with Stephanie Funderburg, Executive Director and a hard copy of report was provided along with Appeal Rights.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20220607112209
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2022
Section Cited
CCR
87468.1(a)(1)
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To be accorded dignity in their personal relationships with staff, residents, and other persons. This was not met as evidence by: based on residents complaining about staff treatment towards them. Which poses a potential health and safety risk for those persons in care.
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Executive director will create and conduct a training for all staff on how to treat resident with respect and kindness. Provide LPA of log with all signatures of staff who attended the training.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6