198603162-3-14-2023-28-AS-RORN-CQCUF7-20230328153217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/14/2023
Date Signed: 03/14/2023 04:48:01 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
03/13/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230313084233

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	HIPOLITO, RHONWINN		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 63	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	03:51 PM
MET WITH:	Operations Manager Michael Forsgren		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff participated in resident council meeting without resident council approval

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced initial complaint investigation for the allegation listed above. LPA met with Operations Manager Michael Forsgren and the purpose of the visit was discussed.
On today's visit , LPA interviewed Staff #1-5 (S1-S5) and Residents #1-#6 (R1-R6) and collected documents related to the facilities resident council meeting. The investigation concluded the following: In regards to the allegation "Staff participated in resident council meeting without resident council approval " it was alleged that S1 participated in the facilities resident council meeting without approval. (5) of (5) staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 is the president of the resident council and R1 invited S1 to attend the meeting on 3/9/23. Interviews with R1 confirms this information that S1 was invited to attend the meeting as a guest prior to it starting. S1 also confirmed the same. Based on interviews and files reviewed; 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 held and a copy of the report was provided

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: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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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