198603162-8-26-2022-28-AS-RORN-CJFU35-20220920151259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 08/25/2022
Date Signed: 08/26/2022 08:06:10 AM

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
07/20/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220720132522

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: 50	DATE:	08/25/2022
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Administrator Pamela Junge		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is retaining residents that threaten the safety of other residents while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit regarding the above allegation. LPA met with Administrator Pamela Junge Administrator and explained the reason for the visit.

Initial visit was conducted on 7/26/22 and consisted of the following: LPA requested a copy of the resident/staff roster. LPA interviewed resident #1-#3 (R1-R3) and Staff #1 (S1), LPA collected the following documents from R2 and R3's file; physicians report, Admissions agreement, identification and emergency information, unusual incident reports on file, needs and services plan.

On todays visit, LPA interviewed staff #2-#6 (S2-S6) and resident #4-#7 (R4-R7). LPA also toured the physical plant. The investigation revealed the following:

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: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

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-20220720132522

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: 08/25/2022

NARRATIVE

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In regards to the allegation "Facility is retaining residents that threaten the safety of other residents while in care." it was alleged that R2 and R3 are threats to the safety of other residents and the facility does nothing about it. (6) of (6) Staff interviewed deny the allegation. (4) of (7) Residents interviewed could not corroborate the allegation. Interviews show that R2 shouts and screams around the facility. Interviews conducted show that staff will intervene and calm R2. There are times where R2 will shout at other residents. LPA reviewed incident report dated 7/16/22 that shows R2 threw a facility computer. Interviews do not show that R2 or R3 have assaulted residents or that facility staff is aware of that and ignoring it. 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 are unsubstantiated.

Exit interview was conducted with administrator 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: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

LIC9099 (FAS) - (06/04)

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