198602264-11-21-2023-11-AS-EMAZ-CXSTSF-20231121135902

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 08/31/2023
Date Signed: 11/21/2023 11:17:24 AM

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
08/10/2023 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20230810121437

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: 19	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Jasmine Hezar/Executive Director		TIME COMPLETED:	02:24 PM

ALLEGATION(S):

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Staff did not give resident medications as prescribed.
Staff did not call 911 for residents in a timely manner.

INVESTIGATION FINDINGS:

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This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 8/31/2023.

On 8/31/2023 LPA Alfonso Iniguez conducted and unannounced complaint visit. LPA Iniguez meet with Jazmin Hezar/Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted interviews:Administrator (A#1), Staff (S#1-S#7), Witness #1(W#1), and residents (R#1-R#8). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#7) Identification and Emergency Information, (R#1-R#7) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#7) Needs and Services Plan, (R#1-R#7) Medication Administration Record (MAR) and (R#1-R#4) MAR notes from 8/1/2023-8/16/23, physical tour, and emergency pull system.
Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 4

Control Number 11-AS-20230810121437

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: 08/31/2023

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff did not give resident medications as prescribed.

The details of the complaint alleged that the facility staff are not providing the prescribed medications to residents.

During the records review, LPA Iniguez observed the following: (R#1-R#7) Medication Administration Records (MAR) and MAR daily notes from 8/1/23-8/16/23. Regarding (R#1)’s Medication Administration Records Notes, LPA observed that no notes were written by MedTech on 8/1/23, the day (R#1) allegedly got a double dose of prescribed medication. No other notes from other days indicated R#1 missed a medication. In addition, LPA observed (R#2-R#7) MAR notes from 8/1/23-8/16/23, and no discrepancies were found. Also, LPA reviewed (R#1)’s LIC 602 (Physician’s Report for Residential Care Facilities for the Elderly), which states that R#1 cannot manage her medications; she depends on the facility staff.

During an Interview with the Administrator (A#1), she stated that residents are getting their medications as prescribed by their physician’s orders. LPA asked the administrator what system the facility follows to give medicines to residents; she said they used the “5 right system” (right medication, right resident, right route (oral or transdermal), right time, right documentation, and right to refuse medication). When it comes to a resident who got the medication as a double dose, the administrator stated that no one has gotten a double dose of medication in the past month.

During interviews with residents (R#1-R#8), 8 out of 8 stated that they needed assistance with their medications, and they did not recall MedTech giving them medication twice the same day. Also, 8 out of 8 did not know if a resident got the wrong dose of their prescribed medications, and they did not know if a resident got an overdose for taking the medication without following the doctors’ orders.

During interviews with staff (S#1-S#7), 6 out of 7 stated that the residents are getting their medications as prescribed by their doctor, and the staff is following the doctor’s orders when giving the medicines to the residents. Also, 6 out of 7 staff stated that they did not know if a resident missed their medication or did not get it as prescribed by the resident’s physician.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230810121437

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: 08/31/2023

NARRATIVE

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Allegation: Staff did not call 911 for residents in a timely manner.

The details of the complaint alleged that staff do not call emergency services in a timely manner.

During the records review, LPA Iniguez inspected the Special Incidents Report records; these SIRs are created when a resident is transported to a hospital due to a medical emergency.

During the physical tour, LPA observed and tested the pull cords system in 5 residents' rooms; the system functioned with no problems.
During interviews with the executive director, Jasmin Hezar (A#1), she stated that when a resident needs emergency assistance, the staff calls EMS immediately and documents the incident in a Special Incident Report. Then, they contact the appropriate parties, such as the resident's physician, family members, or responsible party. Another system the facility has to monitor when a resident needs emergency assistance is the pull cord system located in the front desk area; the system signals with three different colors (green, yellow, and red) when a resident's room has a red circle, it means the resident has pulled the cord and needs immediate assistance. The front desk sees this alert popping -up on the monitor, and she communicates via walkie-talkie or phone to one of the caregivers or MedTechs close to the resident who needs immediate assistance. In addition, memory care caregivers check on residents every two hours or as needed.
During interviews with staff (S#1-S#7), 7 out of 7 staff stated that the facility calls EMS services promptly. Also, 7 out of 7 said the facility provides residents with medical care when needed.

During interviews with residents (R#1-R#8), 8 out of 8 residents responded that the facility calls EMS promptly and stated that they feel the facility will help them with a prompt response in case they need emergency care.

During an interview with (W#1) via email, LPA documented the following: on 10/18/2023, Licensing Program Analyst (LPA) Alfonso Iniguez emailed (W#1) asking them if they knew what time EMT was sent to Terraza Court on 8/7/23. On 11/13/2023 (W#1) replied to an email stating that emergency services were sent on 8/7/23 around 7:43 Am. The time (W#1) provided is different from the time (RP) said on their complaint report to the department.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230810121437

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: 08/31/2023

NARRATIVE

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During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED.

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.

This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 8/31/2023.

California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Jasmin Hezar/Executive Director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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