198603162-4-14-2022-28-AS-FFIS-CEPS8A-20220523133847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/14/2022
Date Signed: 04/14/2022 04:23:56 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
04/07/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220407162336

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: 62	DATE:	04/14/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Pamela Junge		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident sustained an injury from a fall while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a complaint inspection for the above allegation. LPA met with Executive Director Pamela Junge and explained the purpose of the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters and Incident report dated 4/1/22. LPA reviewed Resident #1 (R1) file and obtained copies of Face Sheet, Physician's Report, Services Plan, and admissions agreement. LPA interviewed Staff #1-#4 (S1-S4) and residents #1-#3 (R1-R3). LPA toured the physical plant.

The investigation revealed the following: In regards to the allegation "Resident sustained an injury from a fall while in care" it was alleged that R1 sustained an injury in the facility while intoxicated due to lack of supervision. (4) of (4) staff interviewed denied the allegations. (3) of (3) residents interviewed could not corroborate the allegation. Interviews show that R1 and R2 were privately drinking in R2's room on 4/1/22 when staff walking by observed residents in room 113 acting out of character.

Continued on LIC 9099-C

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: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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-20220407162336

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: 04/14/2022

NARRATIVE

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Upon speaking with R1 and R2, staff noticed residents were intoxicated and R1 had a bump on their forehead. Staff called paramedics and assisted R1 and R2. Interviews do not show lack of supervision as residents were in private behind closed doors. There are no existing laws or regulations that prevent residents from eating or drinking what they please. R1 stated to not have been made to do something against their will. Review of R1 and R2's file does not show limitation on what they are able to eat or drink. R1's file does not show that they need a certain amount of supervision from staff. Based on the interviews conducted, observations and files reviewed, there was not enough supportive evidence to concur 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 Pamela Junge and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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