198602264-12-6-2023-11-AS-EMAZ-CZKSLT-20240117125852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 04/19/2023
Date Signed: 12/06/2023 01:49:52 PM

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
04/10/2023 and conducted by Evaluator Ernand Dabuet

COMPLAINT CONTROL NUMBER: 11-AS-20230410095810

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: 61	DATE:	04/19/2023
		UNANNOUNCED	TIME BEGAN:	02:24 PM
MET WITH:	Jazmine Hezar		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility doesn't have a skilled professional to meet residents needs.
Staff are not providing adequate food service to residents.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Terraza Court facility on 04/18/2023 at around 10:00 AM and was greeted by Administrator Jasmine Hezar (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10-day visit on 04/18/2023. LPA Calderon initiated an investigation into the above-mentioned allegations and conducted a face-to-face interview with Administrator (A1).
Investigation consisted of the following: LPA Calderon interviewed Jasmine Hezar A1, S1-S4, R1-R7. These interviews were conducted on 04/18/2023. LPA Calderon obtained and reviewed the following: Needs and Service Plan (dated 03/10/2021), Physician Report (dated 03/10/2021), dietary meal plan (dated 03/10/2021) and admission orders (dated 03/10/2021) for R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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 3

Control Number 11-AS-20230410095810

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: 04/19/2023

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

Regarding Allegation #1: Facility doesn’t have a skilled professional to meet resident’s needs.

This complaint alleged that the facility does not have a nurse on staff. LPA Calderon conducted an interview with A1. A1 expressed that a nurse is on call and that the facility has a nurse to goes from facility to facility. A1 expressed that A1 hired a full-time nurse. A1 expressed that new staff nurse cannot work if not associated to the facility. LPA Calderon conducted an interview with S1-S4. 4 out of 4 staff expressed that there is rotating nurse that comes to the facility weekly. 4 out of 4 staff said that A1 has hired a new full-time nurse, but there is a backlog on background checks. 4 out of 4 staff said that there is no need for a backup nurse and staff gives the best care possible. LPA Calderon conducted an interview with R1-R7. 7 out of 7 residents said that there are enough staff, and they have no complaints regarding care provided by staff. On 04/14/2023 LPA Calderon obtained and reviewed needs and service plan (dated 03/10/2021) and physician report (dated 03/10/2021) for R1. R1 does not have health issues, ambulatory, lives independent life with little assistance from staff.

Regarding Allegation #2: Staff are not providing adequate food service to residents.

This complaint alleged that there is no food chef that works for the facility. LPA Calderon conducted an interview with A1. A1 expressed that kitchen has currently 2 cooks, A1 expressed that A1 hired a new chef, but the new chef had not accepted the job offer at this time. A1 expressed that there are 2 full time cooks working in the kitchen. A1 expressed that the kitchen staff serves 3 meals per day. LPA Calderon conducted an interview with S1. S1 expressed that S1 has been a cook for 15 years and 2 years working as a cook at the facility. S1 expressed that S1 follows the corporate meal plan which is provided to staff weekly. S1 expressed that the meals are quick and nutritious, and no resident or staff goes hungry due to lack of food. S1 expressed that the dining staff serves 3 meals per day and dining staff does the best possible to serve the residents. LPA Calderon conducted an interview with S2-S4. 4 out of 4 staff said residents are served 3 meals per day and no staff or resident goes hungry from lack of food. LPA Calderon conducted an interview R1-R7. 7 out of 7 residents expressed that the prior chef was great and served great meals. 7 out of 7 residents expressed that the prior chef had also done the food ordering and meals plans for the facility. 7 out of 7 residents expressed that the current cook works there 8 hours per day and serves good food. On 04/18/2023 LPA Calderon reviewed the Assisted Living Dietary Communication plan (dated 03/10/2021) for R1. The dietary plan expressed no salt added, large portions, self-fed, no food allergies. On 04/18/2023 LPA Calderon toured the facility with A1. LPA Calderon toured the kitchen and noted food being cooked, 7-day supply of food was found. LPA Calderon noted residents eating breakfast in the dining room.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230410095810

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: 04/19/2023

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 interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “Facility doesn’t have a skilled professional to meet resident’s needs” “staff are not providing adequate food service to residents “is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Jasmine Hezar (A1)

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3