198602264-6-4-2023-11-AS-MVAO-CTFVPL-20230705163654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 06/04/2023
Date Signed: 06/04/2023 12:20:53 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
02/23/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230223114617

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:	06/04/2023
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Carrena Dixon, Med Tech		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not safeguarding resident personal property.
Staff told authorized representative they could not visit resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Carrena Dixon, Med tech.

The investigation consisted of following: Interviews and Record reviews. On 03/02/23, LPA Soto conducted interview with the Executive Director. The LPA also requested copies of the following documents: For R#1 & R#2 - Face sheets, Pre-Appraisals, Physician's Report, Admissions agreement, Resident personal property and valuables, and Needs and Services plan, and Incident Reports (regarding lost belongings and/or visitor refusal.) On 04/26/23, LPA Soto conducted interviews with S#1 - Executive Director - S#10, & R#1 - R#7. LPA toured the memory care unit and rooms 122A, 117, 133B, 121B, and 123.

Unsubstantiated

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: 06/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2023

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 2

Control Number 11-AS-20230223114617

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: 06/04/2023

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

Based on the LPA's investigation, the investigation revealed the following.

For Allegation 1 – Staff are not safeguarding resident personal property. Interviews with S#1 – S#10, communicated that residents in the memory care unit obviously forget where they put their belongings. They leave their clothes and other items in other resident’s rooms and sometimes take other resident’s things too. They do not do it intentionally, but they just can’t remember or don’t know if it’s there’s or not. When the staff see residents in other resident’s rooms, they redirect them to their own rooms. If they see clothes that don’t belong to the residents in their rooms, they take the belongings back to the appropriate resident. R#1 had misplaced their cell phone, but the staff found it inside the drawer of the night stand next to their bed. The clothes are never misplaced or switched by staff; the residents do that on their own. Staff always makes sure they keep every resident belonging with the appropriate resident. When the laundry is done, staff makes sure all the resident’s gets their own clothes back. Interviews conducted with R#1 – R#7, communicated that they don’t get their clothes stolen or nothing else. The interviews conducted did not concur with the above allegation.

Allegation 2 - Staff told authorized representative they could not visit resident. Interviews conducted with S#1 – S#10, communicated that they have never denied any family member entrance to the facility and/or the right to visit their resident’s. Everyone has the right to visit the resident’s anytime they want. Visitors are even allowed to visit late at night, after visitor hours are over. Interviews conducted with R#1 – R#7, communicated that their family members always come to visit. W#1 communicated that they did not prohibit them from visiting their resident, there was an incident with another resident, where the resident was yelling at W#1 and they had to ask W#1 to leave for that particular day. W#1 returned the next day and was able to visit with R#1 with no more incidents. The interviews conducted did not concur with the above allegation.

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.

An exit interview was conducted with Carrena Dixon, Med Tech 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: 06/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2