198602264-12-9-2022-11-AS-MVAO-CQ6Q2U-20230322114744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 12/09/2022
Date Signed: 12/09/2022 02:16:20 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
12/02/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221202155816

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: 58	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Stephanie Oden, Interim Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not responding to requests for documents in a timely manner.
Staff are not responding to requests for communication in a timely manner.

INVESTIGATION FINDINGS:

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On 12/09/2022 Licensing Program Analyst (LPA) Troy Agard conducted an initial investigation to address the allegations listed above. LPA Agard met with Stephanie Oden, Interim Administrator and explained the purpose of this visit is to gather information and deliver findings.

The investigation consisted of the following: LPA Agard conducted a tour of the facility grounds. The facility is a three-story commercial building. The first floor indicated as “L” consist of the lobby/receptionist area, business offices, living room, library/activity room, dining area, kitchen, staff break room, laundry and medication room. 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 staff and residents. LPA Agard requested 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

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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-20221202155816

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: 12/09/2022

NARRATIVE

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The investigation revealed the following... Regarding the allegation: Staff are not responding to requests for documents in a timely manner. It’s being alleged medical documents were requested due to a pending complaint and documents still have not been received. On 12/09/2022 LPA attempted interviews with 5 out of 40 staff. 0 out of 3 confirmed the allegation. S2 and S5 were both unavailable for an interview. S1 states, “I personally did not receive any request from anyone requesting documents nor was anything said to me.” S3 states,” I know nothing about that. I don’t have any idea about either allegation.” S4 states, “I don’t know anything. No one has reached out to me requesting information.” During interviews with residents, LPA interviewed 5 out of 58 residents, 0 out of 5 could confirmed the allegation. All residents unanimously stated they had no information on the allegation.

Regarding the allegation: Staff are not responding to requests for communication in a timely manner. It’s being alleged the facility staff are not responding to communications being sent.” During interviews with staff 0 out of 3 confirmed the allegation. S2 and S5 were both unavailable for an interview. S1 states, “if a request was given to S2, they are on leave. If a request was sent to me, I would have answered it.” S3 and S4 both denied receiving any communication for requested documentation. During interviews with residents, 0 out of 5 confirmed the allegation. All residents unanimously stated they had no information on the allegation.

LPA was unable to obtain any documentation to review to corroborate the interactions between the facility and reporting party. LPA determined the Administrator has been on a leave of absence since the 3rd week in November 2022. During an interview with the reporting party, it was revealed they have not reached out to any other members of the Administrative team at the facility.

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: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC9099 (FAS) - (06/04)

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