198602264-5-3-2023-11-AS-EMAZ-CRK49E-20230505185413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 05/03/2023
Date Signed: 05/03/2023 04:26:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
04/20/2023 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230420130645

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: 62	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Jasmine Hezar Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff yells at residents in care
Staff does not maintain the facility kitchen area in a sanitary condition
Toxic substances are accessible to residents in care
Residents are not provided with adequate amounts of food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced visit and was greeted by Administrator Jasmine Hezar. LPA Brown explained the purpose of this visit is to gather information regarding the above-mentioned allegations.

Investigation consisted of the following: LPA Brown conducted a tour of the facility grounds. The first and second floor consist of resident's bedrooms and bathrooms, storage, and patio. The Memory Care Unit (MCU) is located on the 1st floor and consist of bedrooms and bathrooms, resident's laundry room, dining/activity room, small kitchen, TV room, offices, and patio. LPA interviewed Administrator and Staff S1-S5, Residents R1-R2 and Witness (W1). LPA Brown requested and obtained the following documents, which were received at the time of visit: 1) a copy of the staff roster, 2) a copy of the resident roster, activity schedule, food handler, refrigerator temperature log,face-sheet for 6 residents, cleaning schedule and Care staff Schedule.
LIC 9099 is on the next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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-20230420130645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 05/03/2023

NARRATIVE

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Regarding Allegation: Staff yells at residents in care.

It was alleged that staff yells and screams and residents in care. On 4/26/23 and 5/3/23, LPA Brown conducted interviews with Administrator and staff S1-S5, staff and administrator stated they have not yelled at residents and have not witness any staff screaming at residents while in care. LPA interview R1-R2 and residents stated had no concerns. Based on investigation the above allegation is unsubstantiated.

Regarding Allegation: Staff does not maintain the facility kitchen area in a sanitary condition

It was alleged that the facility kitchen is filthy, refrigerator dirty and no temperature logs. On 4/26/23 and 5/3/23, LPA Brown conducted interviews with the Administrator, she stated the kitchen is clean daily by kitchen staff on the main level and 1^st ^fl floor Memory Care is cleaned housekeeping/caregivers. LPA conducted Interviews with S1-S5 stated the kitchen is cleaned by caregivers and housekeeper. LPA Brown observed the kitchen area on the main floor and the kitchen/dining, refrigerator was clean. Observation of temperature log was posted and documented. LPA observed the Memory Care kitchen area on the 1^st floor and the kitchen/dining and refrigerator was clean. Based on investigation the above allegation is unsubstantiated.

Regarding Allegation: Toxic substances are accessible to residents in care

It was alleged the kitchen is left unlock with chemicals at armed reached. On 4/26/23 and 5/3/23, LPA Brown conducted interview with Administrator and S1-S5, Administrator and staff stated chemicals are in the storage areas on the main level and 1^st floor and not accessible to residents. LPA Brown observed chemicals with dispenser in the storage areas on the main and 1^st floor. The facility staff uses an Ecolab dispenser system. LPA observed Memory Care kitchen and there was no toxic accessible to residents and kitchen door was locked. Based on investigation the above allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230420130645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 05/03/2023

NARRATIVE

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Residents are not provided with adequate amounts of food

It was alleged resident have little food and no alternative choices. On 4/26/23 and 5/3/23, LPA Brown conducted interview with Administrator and S1-S5, Administrator and staff stated residents are given 3 meals day and including snacks. Residents are able to have 2^nd servings if they wish. Interview conducted with S4 stated food is puree in a blender for 2 residents 3 times a day. LPA observed kitchen refrigerator to have plenty of food such as meats, eggs, fruits, yogurts and snack food. During visit LPA also observed in the dinning room Menu that listed alternative food options. LPA observed storage area to have plenty of can foods and cereal. Complement snacks like fruits and cookies, and cold or hot beverages are available in the concierge bar in the front area of the facility. Observation of Memory Care refrigerator had sandwiches, fruits and yogurt for snack. Based on investigation the above allegation is unsubstantiated

Based on interviews conducted, 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(s) is unsubstantiated.

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

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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