198602264-4-26-2023-11-AS-RORN-CRVNQ7-20230516103929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:23:36 PM

Unfounded

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
04/19/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230419144615

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:	08:38 AM
MET WITH:	Jasmine Hezar, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility failed to provide resident's medical records in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Jasmine Hezar, Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 04/26/23, LPA Soto interviewed Executive Director and W#1. LPA requested and received the following documents on 04/26/23: Resident Roster, Staff Schedule, Copies of (Attorney Letter dated 04/17/23 Label of package containing Attorney letter.) (FEDEX packaging label, FEDEX receipt dated 04/18/23 and FEDEX tracking receipt dated 04/26/23,) of delivery of requested documents. Fax confirmation of documents faxed dated 04/18/23.)

Based on the LPA's investigation, the investigation revealed the following. For Allegation – Facility failed to provide resident's medical records in a timely manner. LPA interviewed Executive Director, she communciated that the Attorney's request was received on 04/18/23, they faxed documents on 04/18/23 and also mailed documents 0n 04/18/23 via FED EX.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
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-20230419144615

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: 04/26/2023

NARRATIVE

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LPA interviewed W#1, they communicated that they had received all the requested document's from Terraza Court in a timely manner. LPA reviewed all records and they showed that the document's requested were delivered in a timely manner to the attorney.

“This agency has investigated the complaint alleging the above mentioned allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
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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