198602264-1-13-2021-11-AS-AJKK-BXTVKW-20210201153100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 11/23/2020
Date Signed: 01/13/2021 09:27:55 PM

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2020 and conducted by Evaluator Jey Cardenas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201002145857

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	JUNGE, PAMELA		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	115	CENSUS: 60	DATE:	11/23/2020
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Greg Becker		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident lost a significant amount of weight while in care
Facility lacks sufficient staffing to meet residents' needs
Facility staff administered resident medication against doctor's orders
Facility staff failed to clean resident's bathroom in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jey Cardenas initiated a subsequent complaint contact to deliver complaint finding regarding the above allegations. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with facility representative, Greg Becker.

On 10/09/2020 LPA conducted initial 10-day complaint investigation and interviewed Reporting Party (RP) and Resident Care Coordinator, Tina Darchia, LPA toured facility and inspected ten (10) resident bathrooms. LPA interviewed staff #1-#7 (S1-S7), and residents #1-#8 (R1-R8). LPA obtained R1s pre-placement appraisal, physician report, Medication Administration Record (MAR), Dr’s orders, and hospital records.

The investigation revealed the following: For allegation: Resident lost a significant amount of weight while in care. RP indicates R1 lost substantial weight, resident was on laxatives since June 2020. R1 was prescribed
See continued LIC9099-C on page #2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

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-20201002145857

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
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 11/23/2020

NARRATIVE

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Continued LIC9099-C page #2

laxatives due to stomach issues, however medication was not discontinued accordingly. LPA requested weight records from facility, S6 indicated that the facility has recently started implementing weight
recording as of October 2020. LPA obtained weight chart for R1 only weight recorded was on date: 10/19/20. On 11/04/20 LPA Cardenas called Primary Care Physician to obtain R1 weight records; in addition, LPA also obtained hospital records and confirmed substantial weight loss of 39lbs from March2020 to October2020. Per facility records, there is no medical condition that would account for resident’s weight loss.

For allegation: Facility staff administered resident medication against doctor's orders. S6 indicates that R1 was prescribed laxatives, MiraLAX for constipation. LPA asked date that Doctor discontinued (DC) laxative, S6 states Dr. DC MiraLAX on 9/23/2020. S6 states facility stopped administering medication MIRALAX on 9/27/2020. LPA observed MAR indicated laxatives were DC on 9/27/2020. LPA asked why medication was administered after DC orders on 09/23/20? S6 indicates that medication may have been continued due to mis-communication, it was possible that facility didn’t get the DC fax.

For allegation: Facility staff failed to clean resident's bathroom in a timely manner, staff interviewed corroborated allegation, LPA was informed that facility doesn’t have a housekeeper assigned to memory care. The assisted living (AL) housekeeper goes over to memory care area once a week. S2 indicated that during shift, a resident in memory care soiled self and got it all over the bathroom’s toilet, sink, walls. Caregiver staff asked the administrator, Pamela to send housekeeper to clean resident bathroom. Pamela responded that this incident happened during that staffs shift and staff is responsible for cleaning. Staff indicated to LPA that job duties are not housekeeper nor clean soil off walls, staff indicated that the residents needed care giving assistance at that time and staff was rendering caregiver assistance.

For allegation: Facility lacks sufficient staffing to meet residents' needs, S1-S5 corroborated allegation that residents’ needs in memory care unit are not being met due to short staffing. S1-S4 indicated that due to short staffing residents are not being showered as often as they should and often have foul odor to them. LPA asked if residents complained to staff about needs not being me, staff says residents don’t complain because they are memory care. LPA asked if there are shower logs to recorded resident showers, S5 indicates that the logs are not being completed due to short staffing and indicated that they don’t know who has showered. S1 states that at times resident were left in bed because there weren’t enough staff to get

See continued LIC9099-C on page #3

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201002145857

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
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 11/23/2020

NARRATIVE

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Continued LIC9099-C page #3

them out. S1-S3 and S5 stated that at times there has only been one staff on shift working memory care. S6 indicates that recently schedules have been updated and there are three (3) caregivers and one (1) med-tech per shift. LPA asked if there has ever been a time when only one caregiver was working a shift, S6 indicates yes, due to staff shortage. Four out of Eight (R1, R2, R4, R6) residents indicated that there isn’t enough staff to assist with their needs. One (R5) resident state sometimes there is enough staff other times there isn’t. R7 indicates staff do not check in on resident, R8 indicates, “I don’t need help” R3 is unsure.

Based on LPA’s interviews conducted, and records 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.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

LIC9099 (FAS) - (06/04)

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Citations on this Visit Report are Under Appeal!

Control Number 11-AS-20201002145857

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
MONTERY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/23/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/04/2020 Section Cited CCR 87466	1 2 3 4 5 6 7	Observation of the Resident he licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional... This requirement not met as evidenced by: LPA obtained records showing substantial weight loss, changes were not recorded. This poses potential health and safety risk for resident.	1 2 3 4 5 6 7	Administrator shall submit self certification indicating that weight will be observed, recorded, medical assistance will be seeked if needed, and responsible person will be notified of changes.
Type B 12/04/2020 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	Once ordered by the physician the medication is given according to the physician's directions This requirement not met as evidenced by LPA reviewed MAR indicating medication was administered after DC date. This poses a potential health and safety risk for resident in care.	1 2 3 4 5 6 7	The licensee shall conduct a staff training on medication administration to ensure that they are providing residents medication accordingly per doctors orders.
Under Appeal Type B 12/04/2020 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The facility shall be clean, safe, sanitary and in good repair at all times...This requirment not met as evidenced by LPA interviewed staff who confirmed bathroom was not cleaned in a timely manner. This poses a personal rights risk to residents in care,	1 2 3 4 5 6 7	Administrator shall ensure that memory care unit residents restrooms are cleaned in a timely manner. Submit plan to LPA outlinig steps facility will take to ensure bathrooms are cleaned regularly.
Under Appeal Type B 12/04/2020 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary...This requirement not met as evidenced by: During staff and resident interviews LPA was made aware of staff shortages. This poses as a potential health and safety risk to residents in care.	1 2 3 4 5 6 7	Administrator shall submit a plan on how facility will ensure that there's sufficient staff to meet residents needs.

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: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey Cardenas	TELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020

LIC9099 (FAS) - (06/04)

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