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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 08/27/2021
Date Signed: 08/27/2021 01:07:42 PM

Substantiated


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
11/09/2020 and conducted by Evaluator Jennifer Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201109161049
FACILITY NAME:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:JUNGE, PAMELAFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: 64DATE:
08/27/2021
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Greg Becker, Admnistrator TIME COMPLETED:
01:32 PM
ALLEGATION(S):
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Resident assaulted another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Jones conducted a subsequent complaint visit and delivered findings for the facility listed above. LPA arrived and met with the administrator, Greg Becker and LPA explained the reason for the visit.

On 11/19/20, LPA Bunker conduted a televisit and interviewed the Administrator, Greg Becker.

On 06/04/21, LPA Bunker coducted a telephonic visit and interviews were conducted with staff and residents via facetime.

On 08/26/21, LPA Jones met with teh administrator and toured the facility assistant living , Memory Care, room #129 including restroom. LPA observed a shower in the restroom in room #129. LPA interviewed the administrator, Greg Becker and staff 2 and 3 about the allegations. LPA also interviewed residents 1-6 about the allegations.
On 08/27/21, LPA delivered findings to teh administrator.
The allegations revealed the following: For allegation(Resident assaulted another resident.) It is being alleged
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
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 6
Control Number 11-AS-20201109161049
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: 08/27/2021
NARRATIVE
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that a resident who staff try to keep separated from everyone else because of the aggressiveness hit another resident while in care and resulted in a black eye. The administrator revealed during an interview conducted that the incident did happen. The administrator stated this incident was already discussed with another LPA and the POC is in process. Staff 2 revealed during her interview that she heard about the incident but did not witness it. Staff 3 stated during her interview that she knows the resident in question but doesn't know if this incident took place because she works in the front. LPA interviewed residents 1-6 about the incident. Some of the residents revealed that they knew the resident in question but did not witness this behavior and the others stated that they live on the assistant living side and this resident resided in memory care.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Exit interview conducted and a copy of the report is being furnished.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20201109161049
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/10/2021
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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Administrator will provide LPA, per fax, Staff training on R1’s service care plan, and provide LPA with staff sign in sheet.

LPA fax number (323) 981-1781.
POC Due Date is 9/3/21
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Based on interviews, observation, and record review, by LPA Camppos on 8/4/21, LPA Campos observed R1 case notes, and the notes state that R6 pushed R1 resulting in injury which posed a potential health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
11/09/2020 and conducted by Evaluator Jennifer Jones
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201109161049

FACILITY NAME:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:JUNGE, PAMELAFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: 64DATE:
08/27/2021
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Greg Becker, Admnistrator TIME COMPLETED:
01:32 PM
ALLEGATION(S):
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Staff are not sufficient in numbers to provide services necessary to meet residents' needs.
Staff are not meeting residents' showering needs.
Facility is malodorous.
Facility is not kept sanitary.
Residents are not accorded dignity in their relationships with staff, residents and other persons.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Jones conducted a subsequent complaint visit and delivered findings for the facility listed above. LPA arrived and met with the administrator, Greg Becker and LPA explained the reason for the visit.

On 11/19/20, LPA Bunker conduted a televisit and interviewed the Administrator, Greg Becker.

On 06/04/21, LPA Bunker coducted a telephonic visit and interviews were conducted with staff and residents via facetime.

On 08/26/21, LPA Jones LPA the facility assistant living , Memory Care, room #129 including restroom. LPA observed a shower in the restroom in room #129. LPA interviewed the administrator, Greg Becker and staff 2 and 3 about the allegations. LPA also interviewed residents 1-6 about the allegations.
On 08/27/21, LPA delivered findings to teh administrator.
The allegations revealed the following: For allegation:(Staff are not sufficient in numbers to provide services necessary to meet residents' needs.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20201109161049
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: 08/27/2021
NARRATIVE
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It is being alleged the facility is short staffed and residents are not cared for they way the ought to be. LPA interviewed the administrator about the allegation. The administrator stated that there was an issue in the past with staffing due to the covid-19 pandemic. The administrator stated that there was a high turnover of caregivers during that time but now the facility is fully staffed. The administrator stated that the facility has additional med-techs, caregivers and the facility also has a staffing agencies that they utilize if they need to. Staff 2 and 3 revealed during their interviews that staffing is good but they can always use backup. LPA interviewed Residents 1-6. 5/ 6 residents revealed during their interviews that staffing is good and they will do whatever hey can to assist with their needs.

For allegation: (Staff are not meeting residents' showering needs.) It is being alleged that the facility is short staff and residents are receiving assistance with showering. Its alleged that memory care unit is the worst - room 129 has no shower and the resident hasn't not been showered in weeks. The administrator revealed during his interview that staff are meeting residents showering needs. The administrator provided LPA with a showering schedule and stated that the facility hired additional staff to meet the needs of the residents. The administrator stated that room #129 did not have a shower at one point but there was not a resident residing in the room during that period. LPA toured the memory care unit and room #129. LPA observed a shower in the bathroom of room #129. Staff 2 stated during her interview that all resident receive assistance with showering and hasn’t received complaint. Staff 3 stated that she works in the front and does not assist with showers. LPA interviewed Residents 1-6 about the allegation. Some of the residents revealed that they are independent and do not require assistance. 2 residents was unable to understand LPAs question and the remainder residents stated they are given assistance with showering and other activity of daily living.

For allegation:(Facility is malodorous.) It is being alleged rooms 125 and 131 in memory care and surrounding area have a foul fishy odor. The administrator denied the allegation and states that house keeping cleans often throughout the entire facility. Staff 2 denied the allegations and stated it might smell because of the trash but housekeeping always tries to keep it clean. Staff 3 stated that she goes up to memory care to drop off mail and denies smelling an odor. Residents 1-6 revealed during their interviews. 1 resident was unable to understand LPA's question and the remainder of the residents stated that they never smell foul odors in the facility. During the visit, LPA Jones toured the entire facility including memory care. LPA was wearing a mask the entire time but did lift mask to smell certain areas in the facility. LPA did not smell a foul odor in the facility.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20201109161049
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: 08/27/2021
NARRATIVE
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For allegation:(Facility is not kept sanitary.) It is being alleged that there is urine soaked clothes are the on closet floors, dirty briefs in trash cans and bedroom floors "caked in feces" in those rooms. It is alleged that housekeeping only cleans 2xs month and it is not enough. The administrator denied the allegation and states that house keeping cleans often throughout the entire facility. Staff 2 denied the allegation and stated housekeeping always tries to keep the facility clean. Staff 3 denied the allegation and stated that the facility doesn't appear to be unsanitary. Residents 1-6 revealed during their interviews. 1 resident was unable to understand LPA's question and the remainder of the residents stated that housekeeping cleans their rooms clean and come into clean once a week. During the visit, LPA Jones toured the entire facility including memory care and it appeared to be clean. LPA was wearing a mask the entire time but did lift mask to smell certain areas in the facility. LPA did not smell a foul odor in the facility.

For allegation: (Residents are not accorded dignity in their relationships with staff, residents and other persons.) It is being alleged that 3 women were given their meals in the salon because staff think "they eat too slow" in the dining room. The administrator stated that due to covid 19 and guidance from DPH, the facility closed the beauty salon, movie room and activity room. The administrator stated that these areas were used for dining but it was advised by DPH. The administrator denied the allegation regarding putting residents inside who eat slow. Staff 2 and 3 revealed during their interviews that some residents ate in the salon because of social distance. LPA interviewed residents 1-6 about the allegations. 2 of the residents was unable to answer LPAs question and the remainder of the residents stated that they have never been asked to eat some where else other than the dining area.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6