198602264-3-16-2022-11-AS-UCOL-CLUT7Q-20221206132908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 12/08/2021
Date Signed: 03/16/2022 11:58:41 AM

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
08/23/2021 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210823093450

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: 66	DATE:	12/08/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Greg Becker		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Resident medication is not managed adequately.
Facility does not have activities.
Resident belongings have gone missing.
Staff do not adhere to the resident care plans.
Staff do not assist residents with oral hygiene.
Staff are not providing assistance with daily hygiene.
Staff are not reporting incidents to resident representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, December 08, 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 (ED) Greg Becker. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-6 (S1-6) and residents 1-7 (R1-7). LPA Bunker and the Activities Coordinator Jasmin Gonzales toured the activity area and medication room. We observed residents’ medications and records. LPA Bunker requested copies of the following documents: personnel record, resident’s rosters, MARS, activities calendar, physicians reports, medical records, shower schedule, laundry schedule, special incident reports, and any other pertinent documents associated with this complaint.

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: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

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-20210823093450

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: 12/08/2021

NARRATIVE

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Continued LIC9099-C page #2

Allegation #1: Resident medication is not managed adequately.

The details of this allegation state resident medication are not managed adequately. An investigation was conducted for the health and safety of residents in placement. The complainant did not observe the resident's medication. Med Techs and LPA Bunker observed the resident's medications and records. The Resident's medications are being dispensed according to their physician's direction. Interviews with residents 1-7 (R1-7) all reported they are receiving their medications according to their doctor's orders. and is not have a problem with their medications.

Allegation #2: The facility does not have activities.

The details of this allegation state facility do not have activities. Staff and LPA Bunker observed the residents engaging in the facility activities. LPA Bunker observed the activities schedule. Staff 1-6 (S1-6) stated the facility does have daily activities. Interviews with residents 1-7 (R1-7) stated that they have an Activity Director and there are particular activities play card games, bingo, music, evening movie, sing, bible study, puzzles, word search, shopping, exercises, outdoor activities, arts & crafts, etc. residents stated they enjoy the activities.

Allegation #3: Resident belongings have gone missing.

The details of this allegation state the resident's belongings have gone missing. The complainant did not observe the facility or residents' belongings. Due to COVID-19, all visits were done virtually. The complainant is reporting a hearsay allegation, she did not observe the missing belongings. There is no evidence to support the allegation mentioned above. LPA Bunker and staff observed residents' rooms there were no missing items. Staff stated this incident may have occurred under the old ownership. An interview with staff 1-6 (S1-6) all denied the allegation. Interviews with residents 1-7 (R1-7) all confirmed their personal belongings have not gone missing.

See continued LIC812 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: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210823093450

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: 12/08/2021

NARRATIVE

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Continued LIC9099-C page #3

Allegation #4: Staff does not adhere to the resident care plans.

The details of this allegation state staff do not adhere to the resident care plans. An investigation was conducted for the health and safety of clients. The complainant did not observe the facility care plan this information is hearsay. There is no evidence to support the allegation mentioned above. LPA Bunker and staff observed the care plan and staff stated that they are adhering to the care plan. Staff 1-6 (S1-6) stated they are adhering to the resident's care plans. Interviews with residents 1-7 (R1-7) all reported that staff is adhering to their resident care plans.

Allegation #5: Staff does not assist residents with oral hygiene.

The details of this allegation state the staff does not assist residents with oral hygiene. An investigation was conducted for the health and safety of the residents. The complainant did not observe the resident's oral hygiene. There is no evidence to support the allegation mentioned above. Staff and LPA Bunker observed residents' oral hygiene and medical records. Residents' oral hygiene is been implemented. An interview with staff 1-6 (S1-7) all denied the allegation. Interviews with residents 1-7 (R1-7) all reported that their oral hygiene is been cared for and staff is doing an excellent job. Their family and their responsible party are notified of any changes in oral hygiene.

Allegation #6: Staff is not assisting with daily hygiene.

The details of this allegation state the staff are not assisting with daily hygiene. An investigation was conducted for the health and safety of the residents. The complainant did not observe the resident's daily hygiene the facility was close to the public due to COVID-19 Pandemic. This allegation is based on hearsay. There is no evidence to support the allegation mentioned. Interviews with staff 1-6 (S1-S6) all denied the allegation and stated staff are assisting with residents' daily hygiene. Interviews with residents 1-6 (R1-6) all reported staff assist all residents that need assistance with daily hygiene.

See continued LIC812 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: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210823093450

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: 12/08/2021

NARRATIVE

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Continued LIC9099-C page #4

Allegation #7: Staff are not reporting incidents to resident representative.

The details of this allegation state the staff are not reporting incidents to the resident representative. Staff stated they report all incidents pertaining to an individual resident to their family member, responsible party as required and they report all special incidents to Community Care Licensing and all the appropriate agencies promptly. Staff 1-6 (S 1-6) stated all incident reports are reported according to Title 22 Regulations. Interviews with residents 1-7 (R1-7) stated the facility staff reported all incidents to their representative immediately. S1-6 and R1-7 all denied the allegation.

Investigation revealed the following: Interviews were conducted with staff 1-6 (S1-S6), and residents 1-7 (R1-7) who stated the allegations are false. The complainant did not observe the resident's medication. Med Techs and LPA Bunker observed the resident's medications and records which were accurate. The Resident's medications are being dispensed according to their physician's direction. Staff and LPA Bunker observed the residents engaging in daily activities. LPA Bunker observed the facility activities schedule posted on the walls. Staff stated the complainant is reporting hearsay allegations, she did not observe the missing belongings. There is no evidence to support the allegation residents' belongings are gone missing. LPA Bunker and staff observed the resident's care plan and staff stated that they are adhering to the care plan. Staff and LPA Bunker observed residents' oral hygiene and medical records. Residents' oral hygiene is been implemented, family members are notified of any changes and resident dental care. Staff and residents stated staff is assisting residents with their daily hygiene. Staff 1-6 (S 1-6) stated all special incident reports are reported according to Title 22 Regulations in a timely manner. Interviews with staff 1-6 (S1-S6) and residents 1-7 (R1-7) all denied the 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.

Exit interview conducted. A copy of the Complaint Investigation Report LIC 9099, LIC 9099-C, and Confidential Names LIC 811 was provided to Executive Director Greg Becker

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

LIC9099 (FAS) - (06/04)

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