198603162-3-2-2023-28-AS-RORN-CQEP5R-20230330110109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/02/2023
Date Signed: 03/02/2023 01:02:44 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
02/23/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230223082336

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: 64	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Diana Marquez Business Office Manager		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility staff stole resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) (LPAs) Jose Villalobos and Erik Zaragoza conducted an intial complaint investigation visit for the allegation listed above. LPA's met with Office Manager Diana Marquez and the purpose of the visit was discussed.

During todays visit, LPAs toured the physical plant, interviewed residents #1-#7 (R1-R7) and staff #1-#4 (S1-S4). Staff #5 (S5) no longer works in the facility and was unable to be interviewed. LPA's also collected copies of the staff and residents rosters. The investigation revealed the following:

In regards to the allegation "Facility staff stole residents's personal property" it was alleged that staff entered R1's room and took documents from R1's personal property. (4) of (4) staff interviewed denied the allegation. (6) of (7) Residents interviewed could not corroborate the allegation. LPA was not provided with date of incident....

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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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-20230223082336

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: 03/02/2023

NARRATIVE

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Interview with R1 stated a staff member entered R1's room to collect hospital notes from R1 but took other documents as well. R1 called out for the staff member to return the documents and the staff did. Interviews with staff deny any knowledge of incident occurring. S5 no longer works in the facility and was unavailable for interview. Based on LPA's observations and interviews; 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.

Exit interview was 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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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