<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:55:04 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
03/02/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220302112849
FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:ATEAIAN, KIMIAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 67DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Sophia Chan and Wellness Director Brooke LamotteTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained a fall while in care
Staff did not notify authorized representative of an incident involving a resident
Staff did not seek timely medical attention for a resident
Facility has inadequate record keeping
Facility has inadequate staffing for the facility
Resident's sliding door is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit regarding the above allegation. LPA met with Administrator Sophia Chan and Wellness Director Brooke Lamotte. The purpose for the visit was explained.

The investigation consisted of the following: LPA obtained a client and staff roster and interviewed Staff #1 – #6 (S1 – S6), and Resident #1-#6 (R1 – R6). Reviewed and obtained copies of R1's File, and toured the physical plant. LPA interviews staff from R1's Hospice Agency.

In regards to the allegation "Resident sustained a fall while in care ", it was alleged that R1 fell in the facility due to lack of care and supervision. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that S1 was pushing R1's wheelchair when R1 suddenly pulled forward and reached out as if to grab something resulting in R1 falling....
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20220302112849
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: 03/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 R1 was assessed and assisted back onto their wheelchair immediately after. This concludes that staff was present and provided care and supervision to R1 even though R1 fell. Based on the interviews conducted and observations, 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.

In regards to the allegation "Staff did not notify authorized representative of an incident involving a resident ", it was alleged that R1 fell on 3/1/22 and R1's authorized representative was not notified in a timely manner. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 fell around 5:40pm and family was contacted minutes after. Staff spoke to R1's authorized representative via phone call after speaking to a separate family member first. R1's authorized representative arrived to the facility within an hour after hearing of the incident as well. Review of documents on file show that R'1s authorized representative is also the durable power of attorney (DPOA). Interviews show that although R1's DPOA was not contacted first, they were still contacted in a timely manner. Based on the interviews conducted and observations, 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.

In regards to the allegation "Staff did not seek timely medical attention for a resident", it was alleged that staff did not assess R1 and provide first aid on 3/1/22. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 was assessed after falling and no physical injuries were observed that required immediate medical attention besides first aid care. R1 was assisted to their room and provided an ice pack by staff. LPA Villalobos reviewed an incident report stated that Resident was assessed and provided first aid. Based on the interviews conducted and observations, 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.

Continued on LIC 9099-C
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220302112849
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: 03/10/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation "Facility has inadequate record keeping ", it was alleged that the facility does not keep hospice care documents and notes on file in order to contact them regarding any incidents or changes that occur with R1. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that on 3/1/22 facility staff did contact R1's hospice agency about R1's fall. Hospice agency staff confirmed. LPA reviewed R1's files in the facility and was provided with R1's Hospice binder with contact information. Based on the interviews conducted and observations, 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.

In regards to the allegation "Facility has inadequate staffing for the facility", it was alleged that facility staffing is not enough to provide adequate care and supervision to residents. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Review of staff roster demonstrates that the facility keeps med techs and caregivers on all shifts. Interviews show that even though 2 staff quit recently, other staff have worked overtime and the facility works with a 3rd party agency in order to keep the facility staffed. During the visit LPA observed sufficient staffing providing care and supervision to residents. Based on the interviews conducted and observations, 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.

In regards to the allegation "Resident's sliding door is in disrepair ", it was alleged that the sliding door in R1's room did not lock. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. LPA toured the room with S1 and S1 was able to demonstrate that the door locked. LPA also recorded the door being locked. Based on the interviews conducted and observations, 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.

Citation is being cited on a separate 809. Exit Interview conducted with administrator Sophia Chan and a copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3