198603162-4-25-2021-28-AS-MVAO-C2WNY4-20210511105206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/25/2021
Date Signed: 04/25/2021 03:05:04 PM

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
11/21/2019 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191121103330

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	ATEAIAN, KIMIA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 868-9761
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 64	DATE:	04/25/2021
		UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Aide Alba		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility failed to seek timely medical attention for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez initiated a telephonic subsequent complaint investigation to deliver investigation findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Wellness Director Aide Alba.

Investigation consisted of the following: During the initial visit conducted on 11/25/19, LPA Gonzalez requested a copy of Staff and Resident rosters. LPA and Administrator Mona Tirado conducted a health and safety check which included a tour of the entire facility inside and out. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats during the tour. On 4/28/20, LPA Flores conducted phone interviews with Residents 1-8 (R1-8). On 4/29/20, LPA Flores conducted phone interviews

(See LIC 9099C for continuation of report)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2021

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-20191121103330

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: 04/25/2021

NARRATIVE

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with Staff 1-6 (S1-6). On 4/13/21, LPA Gonzalez conducted a telephone interview with Operations Manager Ryan Gallion and R5's daughter. On 4/16/21, LPA Gonzalez conducted a telephone interview with Wellness Director Aide Alba and requested documents pertaining to R5. On 4/19/21, LPA Gonzalez conducted a telephone interview with Staff Hannah Bolster and followed up with Wellness Director regarding document request. On 4/21/21, LPA Gonzalez received the following documents via email from Wellness Director Aide Alba: R5's Preplacement Appraisal Information dated 11/13/19, Medical Documents dated 12/4/19, Physician's Report for Residential Care Facilities for the Elderly dated 11/8/19, and a list of R5's medications.
The investigation revealed the following: In regard to allegation, Facility failed to seek timely medical attention for resident, it is alleged that as R5 was being transferred by two facility staff, they slipped and R5 fell and used their right arm to brace the fall. R5 immediately felt pain in their arm and asked facility staff to send them to the Emergency Room. It is alleged that facility staff refused to send R5 to the hospital and told R5 that they would be "ok". R5 went to a scheduled orthopedic appointment where they told their doctor what happened at the facility and the doctor noticed a deformity and swelling to R5's right arm. R5's arm was splinted at the orthopedic office and they called 911. Paramedics also noticed that R5 had swelling to their arm. Resident was given 100mcg Fentanyl for pain management and transported to Alhambra Hospital. Interviews conducted with Staff 1-4 and S6 stated that residents that sustain a fall or report that they are hurt or not feeling well are immediately assessed at the facility. They stated that a resident is given first aid at the facility and if higher level of care is needed staff will call 911 so that the resident may be properly treated. Interview conducted with Wellness Director revealed that R5 was not dropped by facility staff but R5 fell as they were trying to reach for their phone. She stated that Med Tech Hannah Bolster was right across R5's room and immediately responded to R5's call for help as R5 had pressed their pendant. Med Tech called Wellness Director who assisted R5 up and Wellness Director then assessed R5 and at that time R5 did not complain of pain. Wellness Director denies that staff dropped R5 or that staff slipped while transferring R5 and stated that if R5 would have indicated that they were in pain, observed R5's arm to be swollen, or R5 requesting to be taken to the hospital, facility staff would have called 911. Interview conducted with Med Tech Hannah Bolster revealed that R5 did not fall while being transferred but that R5 fell while trying to reach for their phone. Med Tech stated that she immediately went to R5's room and called Wellness Director for assistance with picking R5 up. Med Tech stated that R5 did not complain of pain after the fall. Med Tech stated that if a resident wishes to go to the hospital due to not felling well, staff immediately call 911. Interview with R5's daughter revealed that she was satisfied with the treatment given to R5 and she did not have any

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191121103330

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: 04/25/2021

NARRATIVE

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concerns. She stated that she knows R5 was always complaining and would make up false statements to get attention. She stated that R5 was treated at the hospital for Cellulitis due to picking on skin as R5 tended to constantly pick on the skin of both arms and only recalls that R5 when to the hospital for that reason. Interview conducted with R5 revealed that facility is adequate and facility staff give them their medications on time and answer to the pendant when used. R5 stated that they were sent to the hospital by facility once for bending their wrist and after being at the hospital for hours and the hospital not having anyone to take R5 back to the facility, the facility called Uber to take R5 back to the facility from the hospital. Interviews conducted with 6 out of 8 residents revealed that they like the facility and are satisfied with the services provided to them at the facility and if they are in need of a higher level of care facility staff will ensure that they receive it. LPA review of R5's Physician's Report for Residential Care Facilities for the Elderly revealed that R5 had dried scabs on right and left arms and review of hospital documents revealed that R5 was seen at the hospital for Cellulitis and was prescribed Keflex 500mg and Ibuprofen 600mg. Based on interviews conducted with facility staff, facility residents, R5's family member, and LPA review of documents there was not enough supportive evidence to concur with the reported allegation.

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.

Due to measures implemented due to COVID-19, exit interview was conducted with Wellness Director Aide Alba via telephone. A copy of the report was sent via email for signature. A hard copy with signature is on file.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2021

LIC9099 (FAS) - (06/04)

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