198602264-11-10-2020-11-AS-EMAZ-BW3QL3-20201207111514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 11/10/2020
Date Signed: 11/10/2020 05:08:27 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2020 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200526120326

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	ZAMUDIO, JESSE		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	115	CENSUS: 62	DATE:	11/10/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Greg Becker		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Dog at facility has aggressive behavior

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Greg Becker, the facilities Executive Director.

The investigation consisted of the following:

On 6/2/2020 LPA Cifuentes conducted initial 10-day televisit and met with Administrator Pamela Junge. During the call, LPA Cifuentes spoke with administrator, was shown dining room, kitchen, activity room, outside patio as well as resident bedrooms. On 6/11/2020 LPA conducted telephone interviews with staff and residents. LPA requested and received the following documents: facility pet policy/contract for clients, staff roster and client roster.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200526120326

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
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 11/10/2020

NARRATIVE

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Regarding the allegation: Dog at facility has aggressive behavior

The investigation revealed the following:

On 6/2/2020 LPA toured facility. LPA saw dining room, activity room, kitchen, patio and a few resident bedrooms. In video a dog was visible on floor of administrator’s office.

On 6/11/2020 LPA interviewed residents 1-7. Of the resident’s interview 6 out of 7 stated dogs at facility did not have aggressive behavior, they had not been hurt by the dogs nor had any of them jumped on them or run under their feet.

On 6/11/2020 LPA Cifuentes interviewed facility staff. 4 out of 5 staff stated that dogs at facility did not have aggressive behavior, neither they nor clients had been hurt by the dogs and the dogs had not jumped on them or caused them to trip.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020

LIC9099 (FAS) - (06/04)

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