198602264-3-24-2021-11-AS-EMAZ-C7DPPP-20211001112951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 03/24/2021
Date Signed: 03/24/2021 04:41:27 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
10/12/2020 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20201012120716

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: 54	DATE:	03/24/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Greg Becker		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Fire alarms in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Greg Becker, the facilities Executive Director. LPA explained that the purpose of today’s visit was to deliver complaint findings.

The investigation consisted of the following:

On 10/15/2020 LPA Cifuentes interviewed Business Office Manager Galina Tovmasian and toured facility grounds. On 11/5/2020 and 11/23/2020 and 12/3/2020 LPA conducted interviews with staff 1-7 as well as residents 1 through resident 7. LPA requested the following documentation: Staff roster, client roster, report from fire department and fire alarm system maintenance records. LPA Cifuentes received the following documents: Staff roster and Client roster.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2021

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-20201012120716

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: 03/24/2021

NARRATIVE

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Regarding the allegation: Fire alarms in disrepair

The investigation revealed the following:

On 10/15/2020 LPA Cifuentes spoke with Business Manager Galina Tovmasian who told LPA that she has not heard any fire alarms going off, but that she was unaware of any that had possibly happened on the weekends. Ms. Tovmasian explained the pull cord system for a fire in the resident rooms is operational, the maintenance person checked them all. Smoke detectors are spot checked once a month. Ms. Tovmasian stated that there was one day the fire alarm accidentally went off on 10/12/2020 and the fire department came out. She believed one of the residents accidentally pulled it, but there was no fire.

On 10/15/2021 LPA Cifuentes conducted a facility walkthrough with Business Manage Galina Tovmasian. LPA saw no manual fire alarm pulls on first floor, there was a case for a hose, but no hose. LPA was able to see fire alarm pulls in client’s rooms. There were smoke detectors in residents’ rooms and per Ms. Tovmasian there is one in every resident’s room. LPA Cifuentes did not hear or see the smoke or fire alarms go off during tour and conversation with Ms. Tovmasian, nor during interviews with staff and clients on 11/5/2020 and 11/23/2020 or 12/3/2020.

LPA Cifuentes spoke with Administrator Greg Becker on 10/22/2021, 12/3/2021 and 3/24/2021. Mr. Becker explained to LPA Cifuentes that smoke alarms and pull cord system are all connected to a fire/alarm system run by an outside vendor. If something is wrong with one of the smoke detectors, either from a fire, dust, or something else, the smoke detector would light up red, signal the main system which would then start to beep. Mr. Becker also explained that the company only contacts them if there is an issue, such as an alarm going off, to check if there is a fire to then dispatch the fire department. They do not provide maintenance records for the system to the facility. LPA asked when last emergency/fire drill had been conducted and Mr. Becker stated he conducted quarterly drills on 12/3/2020, with a follow-up on 12/18/2020 for those that missed it. He also stated another drill was conducted week of 3/15/2021.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201012120716

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: 03/24/2021

NARRATIVE

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On 11/5/2020 and 11/23/2020 and 12/3/2020 LPA conducted interviews with staff 1 – staff 7. Four of the seven staff stated the fire alarm had not gone off, while three staff stated there had been false alarms.

On 11/23/2020 and 12/3/2020 LPA conducted interviews with resident 1-resident 7. Of the seven residents questioned, four of the seven stated the fire alarm had not gone off, while three of them stated there had been false alarms.

LPA received documentation from facility confirming that all staff shifts had completed a fire drill on 12/3/2020 and 12/18/2020.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be unsubstantiated.

Exit interview conducted, and a copy of the report was emailed to Greg Becker, executive director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2021

LIC9099 (FAS) - (06/04)

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