198603162-11-3-2022-28-AS-RORN-CLQ28F-20221201161016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:50:20 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
12/24/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201224062946

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: 54	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Pamela Junge		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Resident sustained an injury while in care
Staff did not ensure that resident's needs were met

INVESTIGATION FINDINGS:

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

The initial visit was conducted telephonically, due to Covid-19 protocols, on 1/4/21. The investigation consisted of the following: LPA interviewed Resident #1 (R1) and Staff #1- #4. LPA unable to interview Resident #2 (R2) due to client not residing in the facility any longer. LPA requested copies of the following: Staff and Resident Roster, Facesheet, Physicians report, and Needs and Services plans for R1-R2

On todays visit, LPA interview Staff #5 (S5) and Residents #3-5 (R3-R5). The investigation revealed the following: In regards to the allegation "Resident sustained an injury while in care" it was alleged that R2 sustained a facial injury from an unwitnessed fall due to staff negligence in the summer of 2020. (4) of (5) Staff interviewed denied the allegation. (4) of (4) residents interviewed could not corroborate the allegation.

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: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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-20201224062946

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: 11/03/2022

NARRATIVE

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LPA reviewed 2 incident reports in R1's file dated 6/27/18 and 8/21/19. Incident reports did not mention facial injuries. There were no incident reports provided for the timeline provided to LPA. Interviews with staff do not show that R1 had sustained a facial injury from an unwitnessed fall in 2020. Based on LPA's observations and interviews; 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.

In regards to the allegation "Staff did not ensure that resident's needs were met " it was alleged that staff neglect R1 and R1's needs were not being met. (4) of (5) Staff interviewed denied the allegation. (4) of (4) residents interviewed could not corroborate the allegation. LPA was not provided examples as to how R1's needs were not being met. Interview with R1 shows that R1's needs are being met by staff. Interviews with staff shows how staff would meet R1's needs. LPA reviewed R1's needs and services plan to corroborate the information. Based on LPA's observations, interviews, and file review; 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 conducted 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: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

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