198602264-9-24-2021-11-AS-MCAA-C7LUF5-20211008153207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602264
Report Date: 09/24/2021
Date Signed: 09/24/2021 01:21:52 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
01/11/2021 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210111140127

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: 68	DATE:	09/24/2021
		UNANNOUNCED	TIME BEGAN:	01:03 PM
MET WITH:	Greg Becker, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility failed to observe changes in resident's health.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones conducted a subsequent complaint visit and delivered findings for the facility listed above. LPA arrived and met with Greg Becker and the reason for the visit was explained.

During the visit on 08/26/21, LPA toured the facility Assistant living and Memory Care. LPA interviewed the administrator, Greg Becker, staff 2 and 3 about the allegations. LPA requested copies of R1's medical records and attempted to interview residents 2-7.

The allegation revealed the following: For allegation (Facility failed to observe changes in resident's health.) It is being alleged that the facility failed to observe resident’s change in condition. It is also being alleged that the incident occurred due to the facility being short staff. On 08/26/21, LPA interviewed the administrator and staff 2 and 3 about the allegations. The administrator revealed during the interview that the facility

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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-20210111140127

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: 09/24/2021

NARRATIVE

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did have some problems with staff due to covid-19, however the facility did the best of their ability to care for the residents in care. The administrator provided LPA with notes of resident 1 indicating that It was noted on 12/10/2020 that R1 was fine and no new changes. R1 got COVID-19 on 12/31/20 and started to decline due COVID symptoms. R1 started hospice with testing positive for COVID and passed away on Hospice on 01/15/21. Staff 2 revealed during her that R1 contracted covid-19 and declined really fast. S2 said she did not see her while she was in bed because she didn’t work in memory care. S2 stated that she feels like staff tried to keep covid from spreading. S2 said all staff in memory care wore PPEs and kept charts of all of the resident changes. Staff 3 revealed during her interview that she works in the front and did not assist R1. S3 stated that the facility followed protocol to keep covid from spreading. S3 said the facility used PPEs and hand sanitizer to keep from spreading. LPA interviewed residents 2-7. Some of the residents stated that the facility did all they could to keep covid from spreading throughout the facility. The remainder of the residents were unable to understand LPAs questions and was unable to communicate due to their diagnosis. LPA interviewed the hospice agency about the allegation. The hospice agency nurse stated that R1 was already covid-19 positive when resident was admitted 01/09/21. Hospice nurse stated that the facility referred resident to hospice. Hospice nurse stated that family was aware of residents diagnosis and everyone agreed to keep resident comfortable during her transition. Based on documentation and record review, it is unable to determine that the facility failed to observe residents change in condition. Residents death report indicates that resident passed away from primary diagnosis with a secondary of covid -19.

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 unsubstantiated.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC9099 (FAS) - (06/04)

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