198602264-9-17-2021-11-AS-JHAD-C7DQNE-20211001121858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 09/17/2021
Date Signed: 09/17/2021 12:27:27 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2021 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210512140508

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: 67	DATE:	09/17/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director, Greg Becker		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident does not have access to a phone.
Staff did not safeguard resident's personal belongings.
Resident's hygiene needs are not being met.
Resident's bedding is soiled.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Greg Becker, the facility’s Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 08/30/21, LPA Soto interviewed Executive Director, S#2 - S#5, and R#1 - R#6. LPA Soto and Executive Director toured, Memory Care Unit rooms and 1 assisted living room #101, #122A, #125, #136, #138, hygiene storage supplies, lobby, facility phone and cell phone storage, and 2 lobby common restrooms. LPA Soto received the following documents on 08/30/21; Resident Roster, Staff Schedule, Face sheet, Physician's Report, Admission Agreement, Resident assessment, Needs and Services Plan, and photos (R#1 room, bathroom, cell phone and refrigerator.) LPA Soto could not interview R#1, due to family member took R#1 to another facility. Executive Director did not know to what new facility R#1 was transferred to.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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-20210512140508

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
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 09/17/2021

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Resident does not have access to a phone. Interviews with Executive Director, S#2 – S#5, stated that residents in the Memory Care Unit lose their personal items, but they are not lost just misplaced by the individuals themselves, they just do not remember where they leave the items. Most of the time, the staff looks for the items and finds the item somewhere else within the Memory Care Unit. R#1 cell phone was found by staff and returned to R#1. The facility phone is also always available for the residents. LPA Soto observed that the facility was operational and available to all the residents. Interviews with R#2 – R#6, could not answer any of the questions LPA Soto asked the residents. They all just kept quiet, but sometimes mumbled random words. The interviews and records reviewed did not concur with above allegation.

For Allegation 2 - Staff did not safeguard resident's personal belongings. Interviews with Executive Director, S#2 – S#5, stated that residents in the Memory Care Unit lose their personal items, but they are not lost just misplaced by the individuals themselves, they just do not remember where they leave the items. Most of the time, the staff looks for the items and finds the item somewhere else within the Memory Care Unit. R#1 cell phone was found by staff and returned to R#1. The facility provides a photo of R#1 cell phone. Interviews with R#2 – R#6, could not answer any of the questions LPA Soto asked the residents. They all just kept quiet, but sometimes mumbled random words. The interviews and records reviewed did not concur with above allegation.

For Allegation 3 - Resident's hygiene needs are not being met. Interviews with Executive Director, S#2 – S#5, stated that the residents are not left in soiled diapers and they bathe the residents when the schedule says they are required baths. LPA Soto reviewed shower schedule for Memory Unit, it revealed that all the residents that are on the list get their showers as scheduled. LPA Soto observed the hygiene supplies, they had enough hygiene supplies for the whole facility. Interviews with R#2 – R#6, could not answer any of the questions LPA Soto asked the residents. They all just kept quiet, but mumbled random words. The interviews and records reviewed did not concur with above allegation.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210512140508

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
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA COURT	FACILITY NUMBER: 198602264
	VISIT DATE: 09/17/2021

NARRATIVE

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For Allegation 4 - Resident's bedding is soiled. Interviews with Executive Director, S#2 – S#5, stated that they have not seen soiled beddings. S#2 – S#5 also stated that they have never seen soiled mattresses in any shift they have worked. Executive Director also stated that they just change some mattresses from the Memory Unit, but not because they were soiled. They changed the mattresses because they needed new ones. Interviews with R#2 – R#6, could not answer any of the questions LPA Soto asked the residents. They all just kept quiet, but sometimes mumbled random words. The interviews and records reviewed did not concur with above allegation.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

An interview was conducted with Greg Becker, Executive director, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC9099 (FAS) - (06/04)

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