198602264-4-26-2023-11-AS-EMAZ-CRK49G-20230505185419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 04/26/2023
Date Signed: 04/26/2023 05:06:05 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

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:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Jasmine Hezar-Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Staff do not provide activities to residents in care
Staff does not ensure that the facility remains free of odors from incontinence
Resident grooming needs are not met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martessa Brown conducted an initial unannounced visit and was greeted by Administrator. 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-S4. 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 and cleaning schedule.
LIC 9099-C 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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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: 04/26/2023

NARRATIVE

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Investigation revealed the following:

Allegation: Staff do not provide activities to residents in care

It was alleged that residents are not provided activity while in care. On 4/26/23, LPA Brown conducted interviews with Administrator and staff S1-S4, staff and administrator stated residents have activities daily at the facility and have no concerns. LPA reviewed the activity schedule and staff roster that listed activity director and did not see a discrepancy. During today’s visit LPA observed residents having activities in Assisted living and Memory Care area. Based on investigation the above allegation is unsubstantiated.

Allegation: Staff does not ensure that the facility remains free of odors from incontinence

It was alleged that the facility Memory Care unit (MCU) has an overwhelming smell. On 4/26/23, Interview conducted with the Administrator stated had no complaints or concerns regarding smell in the facility. LPA Brown conducted interviews and 3 out of 4 staff stated had no concern with the smell in the facility and had any concerns. LPA reviewed the laundry and housekeeping schedule and did not see a discrepancy. During today’s visit LPA tour resident’s bedrooms and common areas and did not observe any odors while touring the facility. Based on investigation the above allegation is unsubstantiated.

Allegation: Resident grooming needs are not met

It was alleged that the resident in the facility is not well groomed. On 4/26/23, Interview conducted with the Administrator stated residents grooming needs are being met and had no complaints or concerns. LPA Brown conducted interviews with 3 out 4 staff stated residents hygiene needs are being met. 3 out of 4 staff stated they have a schedule to ensure residents hygiene needs are being met. LPA reviewed care staff schedule and observed residents in the facility to be cleaned and groomed. 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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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