198603162-6-16-2022-28-AS-SCOL-CFNTMU-20220623145142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:20:29 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
06/07/2022 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220607114242

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: 57	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Pamela Junge; Executive Director		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Resident was left in soiled diapers for an extended amount of time.
Staff did not communicate with authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Pamela Junge (Executive Director) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) file and obtained copies of Identification and Emergency Information Form, Physician's Report, Resident Appraisal, and Service Request. LPA also interviewed the Executive Director, Staff #1 - Staff #3, and Resident #1 - Resident #8.

The investigation revealed the following: in regards to the allegation "resident was left in soiled diapers for an extended amount of time", it is alleged that on 06/05/22 (R1) was observed in a soiled diaper. It is unknown how long (R1) was in the soiled diaper. Interviews conducted with staff members deny the allegation. Staff members interviewed indicated R1 does not use diapers and does not require continence assistance, but does require prompting. Review of R1's Service Request Plan & Physician's Report indicates that R1 is continent of bowel and bladder and is independent of toileting assistance. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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-20220607114242

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: 06/16/2022

NARRATIVE

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R1 indicated that she does not need toileting assistance from facility staff. R1 indicated she does not recall if she was soiled on Staff members interviewed indicated that residents are checked on at least every 2 hours and will assist residents by taking them to the bathroom or with diaper changes. 8 out 8 residents interviewed indicated that they are happy with the services they receive at the facility. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "staff did not communicate with authorized representative", it is alleged that sometime between 05/30/22 - 06/01/22, R1 was moved to a different room without explanation. It is alleged that R1's Responsible Party was not notified of the room change. Interview with Executive Director confirmed that R1 was temporarily moved to a different room due to roommate incompatibility. Executive Director indicated she attempted to notify R1's Responsible Party on 05/29/22 when R1 was moved, but was unable to reach Responsible Party and left a voicemail informing them of the room change. Executive Director indicated she also spoke to R1's Responsible Party on 06/06/22 and informed them of the temporary room change. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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