198603162-9-18-2020-28-AS-MVAO-BXMRYA-20210126122559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 09/17/2020
Date Signed: 09/18/2020 11:53:56 AM

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
09/08/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200908101334

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: 58	DATE:	09/17/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Mona Tirado and Wellness Director Aide Alba		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not answering residents pull cords timely

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jose Villalobos initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Mona Tirado and Wellness Director Aide Alba.

The investigation consisted of the following: LPA conducted a virtual tour of the facility and resident rooms with administrator Mona. LPA conducted phone interviews with the Administrator, Staff #1 - Staff #6 (S1-S6), Resident #1- Resident #10 (R1-R10). LPA also recieved a copy of the resident and staff roster via email as well as the Plan of Operation.

The investigation revealed the following: in regards to the allegation "Staff are not answering residents pull cords timely", it is alleged that staff took longer than 30 minutes to assist R1 once they pulled the emergency cord in their restroom...

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2020

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 2

Control Number 28-AS-20200908101334

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: 09/17/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During virtual tour of the facility, LPA was able to observe and test the resident pull cords in rooms 105, 202, 222, 230 and 235. Each time the cords were pulled staff was alerted and arrived to the rooms within 2 minutes to assist the residents. LPA observed that staff carry pagers connected to the facilities alert system so they know which room # the signal is coming from. Staff was also observed communicating through walkie talkies to confirm if the resident has been assisted. (6) of (6) staff members interviewed denied that it has ever taken more than 30 minutes to answer a resident pull cord. (9) of (10) Residents interviewed also denied having to wait long for staff to arrive once an emergency pull cord is used and have had no issues when needing to communicate with staff. Based on interviews conducted with facility staff and clients, there was not enough supportive evidence to corroborate with the reported 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 UNSUBSTANTIATED.

Exit interview was conducted with administrator Mona Tirado and wellness director Aide Alba, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 2