198602264-4-19-2023-11-AS-RORN-CRVM6F-20230516091951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 04/19/2023
Date Signed: 04/19/2023 09:49:05 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
04/11/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230411132934

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: 61	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Jazmine Hezar		TIME COMPLETED:	03:57 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is malodorous.
Residents are not provided mail in a timely manner.
Staff are not providing snacks to residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 04/19/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility, LPA was greeted by Executive Director Jazmine Hezar. LPA explained the purpose of the visit is to investigate the allegations mentioned above.

The investigation revealed the following: The complainant requested an investigation concerning resident #1 (R1). LPA obtained copies of the facility roster for residents and staff. Interviews conducted with staff #1-#5 (S1-S5) and residents #1-#6 (R1-R6) A reviewed of (R1)'s service records and other pertinent documents associated to the allegations on this complaint. A tour of the facility was performed.

(Evaluation Report continues on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20230411132934

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: 04/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility is malodorous.

The complainant alleged the facility is malodorous. The complainant had no further details on this allegation nor provided demonstrative evidence. The complainant stated during an interview that this problem is no longer an issue. The Department inspected the facility on 04/19/23 and observed the facility to be clean, sanitary and maintained in order. The facility did not exude any unpleasant odor. During the visit on 04/19/23, the Department observed staff (S4) performing housekeeping duties. An interview with (S1-S4) expressed that they continue to ensure that the facility is in healthful conditions due to COVID-19. (S1) stated staff is instructed to keep the facility in a safe and sanitary environment for residents, staff, and visitors. Residents #2-#6 (R2-R6) reported they are pleased with the condition of the facility and stated their rooms are clean, sanitary, and odor free. Based on interviews and observation of communal areas and private rooms, there is no evidence to support the allegation mentioned above.

Allegation: Residents are not provided mail in a timely manner.

The complainant alleged the residents at this facility are not provided mail promptly. The complainant stated this concern was made in general for all residents and did not have an issue with USPS mail or packages not being delivered promptly. The complainant did not have a name, date, day, or time when the incident occurred. Interviews with staff #1, #2, and #5 (S1, S2, and S5) stated that the mail is delivered to the resident the same day it arrives. (S1) stated the mail is delivered by USPS mail at the receptionist desk. The mail is sorted by (S5) and distributed by (S5) by notifying the residents. The residents come to the front desk to retrieve their mail. (S5) stated by the end of the day if the resident is unable to retrieve their mail, it is taken personally by staff to their room. According to (S5) no mail is held at the desk overnight. Interviews with residents #1-#6 (R1-R6) did not have issues with their mail or packages delivery. During the inspection visit, the Department did not observe overnight mail withheld at the front desk. Based on information gathered, there is no evidence to corroborate the allegation mentioned above.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230411132934

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: 04/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff are not providing snacks to residents.

The details of the complaint reported the facility never had enough snacks for residents in care. The complainant stated that no in-between snacks are offered to residents in care. The complainant was unable to provide additional details on this allegation. An interview with staff #1-#3 (S1-S3) reported that snacks are available to residents 24/7. Complimentary snacks like fruits, cookies, and cold or hot beverages are available in the concierge bar in the front area of the facility. (S1-S3) also stated in-between snacks are offered in assisted living and memory care at 10:30 am, 2:30 pm, and any time after 6:00-10:30 pm. The activities directors performs a door-to-door room service and offer snacks to residents in both assisted living and memory care. The Department observed a snack list posted inside the kitchen. These snacks include yogurt, fruits, cookies, ice cream, and a selection of cold or hot beverages. An interview with residents #2-#6 (R2-R6) claimed they had no issues or concerns about snacks provided at this facility. The Department observed the concierge bar filled with a selection of fruits and beverages. The Department conducted inspected the food supply and observed the facility is following General Food Service Requirements Section 87555, Title 22 Regulations. The Department observed food supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. The food supply included milk products, meat, vegetables, fruits, bread, cereals, juices, and sweets. A weekly menu was posted and made available for review for residents. A review of the facility's Admission Agreement under Basic Services includes: "three (3) meals daily and in-between meals snacks as part of the basic monthly fee". (R2-R6) expressed they have never run out of snacks. . Based on information gathered, there is no evidence to support the allegation mentioned above.

Based on the information gathered, an inspection of the facility, observation, and interviews conducted, the Department found no evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies were cited during this visit.

An exit interview was conducted with Executive Director Jazmine Hezar, and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3