198603162-10-7-2020-28-AS-MVAO-BX7SFR-20210112125046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 10/02/2020
Date Signed: 10/07/2020 07:59:18 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2019 and conducted by Evaluator Renee Arterberry

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191230103751

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	ATEAIAN, KIMIA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 868-9761
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 62	DATE:	10/02/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mona Tirado, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident not provided clean linens
Resident's room is malodorous
Resident is not being bathed
Staff not administering resident's medications as prescribed
Staff do not respond to resident's calls for assistance
Staff confiscated resident's call button
Resident not provided assistance with incontinence care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ren’ee Arterberry initiated a Complaint Follow-Up Visit to investigate the allegations noted above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures today's complaint investigation visit was conducted telephonically with Whittier Glen Assisted Living administrator Mona Tirado and the purpose for the call was discussed.

The investigation consisted of the following: on 01/08/2020 LPA Rivas conducted file reviews, at 10:15 AM LPA Rivas reviewed medications and medical records. LPA Rivas interviewed; the administrator, two caregivers, a housekeeper and a medication technician (over the phone) for a total of five (5) staff and they shall be referred to as; S1, S2, S3, S4 and S5. LPA Rivas also interviewed a total of seven (7) residents and they shall be referred to as; R8 through R14. In addition, LPA Rivas interviewed a family member who was visiting a resident during the course of the visit and they shall be referred to as, FM. In addition, LPA Rivas also toured the physical plant at 2:00 PM. The purpose for today's visit is to interview additional residents and they shall be referred to as, R1, R2, R3, R4, R5, R6 and R7.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

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 28-AS-20191230103751

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 10/02/2020

NARRATIVE

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The LPA randomly selected and interviewed seven (7) residents. The purpose for today's visit is to also interview another medication technician and she shall be referred to as, M1. The LPA also tested the Emergency Assistance System at 4:20 PM.

The investigation reveal the following: Resident not provided clean linens: the administrator and S3 state that the linens are changed once a week and more often if needed. R1 state that one day the linens were not changed on her bed and she had to lay on them until housekeeping came and changed the linen. R1 further state the incident happened only once and she do not remember when. R2 through R14 state that the linens are changed weekly and more often if needed or requested. The finding based on the evidence, interviews conducted is unsubstantiated.

Resident's room is malodorous: the administrator, S3 and all residents state that the resident's bedrooms are cleaned two to three times a week. S3 further state that after cleaning the residents bedrooms the housekeepers use air freshener to spray the bedroom. All residents deny smelling unpleasant odors in their bedrooms after housekeeping has cleaned the bedroom. After cleaning, the housekeeping staff spray the bedroom. The finding based on the evidence, interviews conducted is unsubstantiated. Resident is not being bathed: all caregivers state, their duties are; hygiene care; bathe, comb hair, brush teeth and take the resident to the dining room for breakfast. All residents state, they are assisted with hygiene daily and more often if needed. All residents deny that they have not been bathed, "in a long time". The incontinent residents also state that their diapers are checked throughout the day and changed if needed. The finding based on the evidence, interviews conducted is unsubstantiated.
Staff not administering resident's medications as prescribed: During the medication records review conducted by LPA Rivas on 01/08/20. The LPA reviewed; medications, medical records, doctor's orders for medications for which facility is assisting, including PRNs . Per review medications are provided as prescribed. In particular, LPA viewed PRN acetaminophen 500 mg having been administered as per doctor's orders. M1 and S4 state that all medications are administered as prescribed by the physician. All residents state, their medications are administered as prescribed by their physician. The finding based on the evidence, interviews conducted records reviewed and medications viewed is unsubstantiated. Staff do not respond to resident's calls for assistance: S1, deny any issues with call buttons, not aware of any; known or in the past. All residents who have used the Emergency Response System state that staff/caregivers arrived to their area fast. The resident deny that it took staff/caregivers an hour to arrived to their area.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20191230103751

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 10/02/2020

NARRATIVE

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The administrator state during the late evening of 12/23/19 It was discovered that R1's pendant was non-operational. A caregiver took the pendant, left it for the administrator to repair the pendant and returned it back to R1 during the AM shift on the next day. Based on the evidence: interview conducted the finding is unsubstantiated.
Staff confiscated resident's call button: R1's call button was broken and staff gave her a new one. M1 state that when a resident push the Emergency Response Button, staff go to the residents areas as soon a possible. During the course of the visit (via Facetime) the LPA randomly selected by directing M1 to test the Emergency Assistance System at 4:20 PM in one of the resident bedrooms. The LPA and M1 observed that a caregiver arrived to the bedroom at, 4:25 PM. All residents state that they have used the Emergency Assistance System and staff came to their location right away. All residents deny pushing the Emergency Assistance Button and it took staff/caregivers an hour to arrive to provide assistance. Based on interviews conducted and visual observations the finding is unsubstantiated. Resident not provided assistance with incontinence care: the administrator, S1 and S2 state the incontinent residents diapers are changed as often as needed. S2 has changed R1's diaper. S1 also state that diapers are changed at least 5 to 6 times on his shifts. S2 further state her duties include; getting them up and check diapers. R1, R2, R3, R6, R7, R11, R12, R13 and R14 are incontinent. All incontinent residents state that they are checked and changed throughout the day. All incontinent residents deny that their incontinent needs are not being met.
FM state, that a member or two of their family visit the center almost daily. "The caregivers maintain my father's hygiene, ensure his medications are given as instructed per the physician's orders. My father is not incontinent. But he did fall a few days ago and called for staff by pushing the button. He said the staff came right away and they called my sister the same night he fell. My father's bedroom does not have an unpleasant odor. The linens are changed daily and his room cleaned. The state of California, Department of Social Services, Community Care Licensing investigated the allegations of; resident not provided clean linens, resident's room is malodorous, resident is not being bathed, staff not administering resident's medications as prescribed, staff do not respond to resident's calls for assistance, staff confiscated resident's call button and resident not provided assistance with incontinence care. The finding based on the evidence; interviews conducted, visual observations, records reviewed and medications, the finding is unsubstantiated. Reviewed medications, medical records, interviewed the administrator, caregivers, housekeeper, 14 residents medication technicians were interviewed. The Emergency Assistance System was tested and staff arrived to the resident's bedroom in 5 minutes. 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 complaint investigation of the allegations is unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22, An exit Interview was conducted via telephone with the administrator and a hardcopy was provided via email for signature. Signatures on hardcopies.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2020

LIC9099 (FAS) - (06/04)

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