198602264-7-26-2024-11-AS-RORN-D9PSPK-20241003140316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 07/25/2024
Date Signed: 07/26/2024 09:39:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
07/17/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240717122225

FACILITY NAME:	TERRAZA COURT		FACILITY NUMBER:	198602264
ADMINISTRATOR:	HEZAR, JASMINE		FACILITY TYPE:	740
ADDRESS:	10955 WASHINGTON BLVD		TELEPHONE:	(310) 838-7800
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	170	CENSUS: 69	DATE:	07/25/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Brittany Kavanaugh		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not distribute a resident's medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, July 25, 2024, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Brittany Kavanaugh. LPA Bunker explained the purpose of today's visit.
The investigation consisted of the following: Interviews were conducted with staff 1-2 (S1-S2) and residents 1-6 (R1-R6). LPA Bunker asked questions pertinent to the nature of the complaint. Med Tech Carrena and LPA Bunker toured the medication room, observed residents' medications, and reviewed Medication Administration Records (MARs). LPA Bunker requested and reviewed the resident's records. LPA observed the physician's report, physician's orders, medical records, admission agreement, ID and emergency information, MARs, daily medication taken, medication log, medical assessment, consent forms, hospital records, hospice records and notes, centrally stored medication distribution record, appraisal & needs service plan and residents and staff roster. LPA Bunker requested copies of supporting documents.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

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-20240717122225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 07/25/2024

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Staff did not distribute a resident's medication as prescribed.
During interviews with Staff 1-2 (S1-S2) and Residents 1-6 (R1-R6), all stated that the staff is administering the resident's medication according to the doctor’s orders. S2 stated resident was not feeling well and was vomiting. Staff called 911, and the resident was transported to Southern California Hospital for medical treatment then the resident was transferred to Kaiser Permanente Cadillac resident's primary care hospital. LPA Bunker observed residents' records confirmed that medications were being dispensed accurately and in accordance with the physician's directions, with appropriate documentation. S1-S2 stated that the resident is on hospice care and has a prescription for Morphine, which is prescribed on an as-needed basis and is rarely administered. S1-S2 stated that a Kaiser Hospice nurse manages the resident's Morphine medication. The Med-Techs have not dispensed any Morphine to the resident since the resident's admission. S1-S2 stated that the resident had not been administered any Morphine or had access to any narcotic medication at the facility. S1-S2 stated the hospital records corroborated that no mention of narcotics were found in the resident's body, and there was no evidence of a medication overdose. R1-R6 stated they are happy living at the facility and that the staff is dispensing their medications according to the doctor's orders. Both S1-S2 and R1-R6 denied the above allegation.
Investigation revealed the following: Staff 1-2 (S1-S2) and residents 1-6 (R1-R6) interviews all stated that medications are administered according to the doctor's orders, with accurate records and documentation. S1-S2 and R1-R6 stated the facility staff is distributing residents' medications as prescribed. The resident, on hospice care, has a Morphine prescription managed by a Kaiser Hospice nurse and has not received Morphine from facility staff. S1-S2 stated there was no access to narcotic medication at the facility, and hospital records showed no mention of narcotics in the resident's body. S1-S2 stated that the staff is trained in dispensing medications and receives ongoing training. S1-S2 ensured that medication dispensation strictly follows each resident's physician's directions and that none of their residents overdosed on any medication while in care. S1-S2 and R1-R6 denied any medication mismanagement.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Executive Director Brittany Kavanaugh.
There were no deficiencies cited. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

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