198603162-4-20-2022-28-AS-SCOL-CERNZP-20220525105438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/20/2022
Date Signed: 04/20/2022 01:34:44 PM

Unsubstantiated

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
02/22/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220222111310

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	ATEAIAN, KIMIA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 59	DATE:	04/20/2022
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	Pamela Jungi - Executive Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility not following doctor's orders.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted a subsequent unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Pamela Jungi (Executive Director) and explained the reason for the visit.

The investigation consisted of the following: On 03/03/2022, LPA obtained a copy of resident and staff rosters, copies of face sheet, physician report, preplacement appraisal information, medication records, and hospice care documents for Resident 1 (R1). LPA also interviewed the Wellness Director, Hospice Care Case Manager, and Resident 1 (R1). On today's visit, LPA obtained a copy of resident and staff rosters, copies of February & March 2022 medication log for Resident 1 - Resident 7 (R1 - R7). LPA interviewed the Executive Director, Staff 1 - Staff 2 (S1 - S2), R2 - R7 and Hospice Care Nurse.

Regarding the allegation "facility not following doctor's orders", it is alleged that the hospice care agency ordered the facility 02/12/22 to stop using the baby powder under R1's belly flap.
(CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

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 28-AS-20220222111310

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: 04/20/2022

NARRATIVE

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The baby powder was not prescribed by any doctor and was provided to the facility by R1's responsible party. The facility was applying baby powder around R1's private area and under R1's belly flap. On 02/12/2022, it is alleged that a nurse from the hospice care agency and R1's responsible party were at the facility and ordered the facility to stop using baby powder on R1. On 02/19/2022, R1's responsible party visited R1 and observed S1 still using the baby powder. It is believed that the baby powder was causing a rash under the belly flap and that is the reason why the facility was asked to stop using it. Interviews conducted with the nurse and case manager from the hospice care agency revealed that they have no documentation stating to stop using the baby powder in their records for R1. Interviews conducted with staff revealed that they stopped using the baby powder under the belly flap area per R1's responsible party request and also placed a sticker on the baby powder bottle that states "don't use under belly". Furthermore, the claim that the baby powder is the reason for the rash is unlikely unless R1 has an allergic reaction to the baby powder. Review of R1's physician report indicate that R1 has no known allergies. On 02/24/2022, the hospice care agency ordered Nystatin and provided it to the facility on 02/26/2022 to use for the belly flap rash.

Furthermore, it was also alleged that facility was not providing R1 with the PRN medication Tylenol when it was needed. On 02/23/2022, R1's responsible party took R1 to the doctor and R1 received a tetanus shot. R1 is non-verbal and therefore unable to communicate when in pain. Interviews conducted with staff revealed that they did gave R1 Tylenol on 02/24/2022 at 6:26pm because R1 was refusing to take the medication all day. R1's medication records show that the PRN medication Tylenol was administer on 02/24/2022 6:26pm, 03/06/2022 2:55pm and 8:15pm, and 03/07/2022 5:00pm. Interviews conducted with residents revealed that they have no issues with receiving their PRN or any medication.

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

Exit interview held and a copy of the report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022

LIC9099 (FAS) - (06/04)

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