198603162-11-7-2022-28-AS-RORN-CLNR57-20221130114239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 11/07/2022
Date Signed: 11/07/2022 09:23:08 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
03/18/2022 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220318101435

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:	11/07/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Itzayana Barba- Operations Manager		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Facility mismanged resident's medications.
Staff did not administer medications per doctor's orders.
Staff did not treat the resident with dignity.

INVESTIGATION FINDINGS:

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***Please note: This LIC9099 report supercedes LIC9099 report dated 09/13/2022 to include additional information; However, the findings remain the same.***

On 09/13/22, LPA Maldonado made an unannounced, subsequent complaint visit to at the facility regarding the above mentioned allegations. LPA Maldonado met with Executive Director Pamela Junge and explained the purpose for the visit. LPA Maldonado requested a copy of the staff and resident roster, and the following documents for Resident# 1 (R1): Facesheet, Physician's Report, Pre-Placement Appraisal, Medication Administration Records (MARs) for February-March 2022, Incident Reports for February-March 2022, and Hospital Discharge Documents. LPA also interviewed Staff# 1-4 (S1-S4) and Residents# 2-7 (R2-R7). LPA was unable to interview R1 due to resident no longer residing at the facility.

(Report Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

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-20220318101435

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: 11/07/2022

NARRATIVE

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On 03/23/22, LPA Kruz Long made an initial complaint visit and obtained a copy of the Staff schedule, Resident roster and Resident #1's records (Hospital discharge documents, Preplacement Appraisal Information, Physicians Report). LPA Long also interviewed Staff #1 in the conference room at 11:15 am.

Regarding allegation: Facility mismanaged resident's medications.
Executive Director Pamela was unable to provide R1's MARs as resident was able to administer and store own medications. Per R1's physician's report, it was confirmed R1 was able to store/administer own medications. Per R1's hospital discharge documents, it was discovered that R1 was prescribed Tramadol 25mg, 0.5 tabs as PRN (as needed) medication for pain, to be taken for 7 days. The medication was ordered and started on 2/26/22 at 8:34 a.m. and was to be taken until 3/5/22. Per R1's facesheet, it was discovered that R1 resided at the facility from 3/01/22-04/01/22. The documents revealed that by the time the R1 would have arrived at the facility, R1 would only have a few more days of medication left to be administered. During interviews conducted with R2-R7, (3) of (6) residents stated staff assist them with administering their medications and have never had an incident where medications were mismanaged. (6) of (6) residents stated they have no knowledge of residents stating that the facility mismanaged the residents medications. During interviews conducted with S1-S4, (4) of (4) staff stated they have no knowledge of an incident where the facility mismanaged resident medications. If they had knowledge, they would report it right away to Licensing, their physician, and the families.

Regarding allegation: Staff did not administer medications per doctor's orders.
During interviews conducted with S1-S4, staff always administer medications per doctor's orders. During interviews with R2-R7, (3) of (6) residents who are assisted by staff with administering their medication, stated that they have no concerns with staff not administering their medications per doctor's orders. (6) of (6) residents have no knowledge of an incident where a resident expressed that staff did not administer their medication per doctor's orders.

Regarding allegation: Staff did not treat the resident with dignity.
During interviews conducted with R2-R7, (6) of (6) residents state they have never felt like staff did not treat them with dignity. (1) of (6) residents stated there is 1 resident they witnessed to be teased behind their back about their weight and "feels bad" about that occurring. During interviews conducted with S1-S4, no one has witnessed or has knowledge of other staff not treating residents with dignity. Al staff interviewed stated if they had knowledge, they would report it. (Report Continued on LIC9099-C...)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220318101435

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: 11/07/2022

NARRATIVE

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Based on the interviews conducted, observations and files reviewed, 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.

During the visit, no deficiencies were observed or cited.

An exit interview was conducted with Operations Manager Itzayana Barba and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2022

LIC9099 (FAS) - (06/04)

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