198603162-3-28-2023-28-AS-RORN-CR8QZM-20230425123657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:46:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/20/2023 and conducted by Evaluator Luis Mora

COMPLAINT CONTROL NUMBER: 28-AS-20230320090047

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: 62	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Michael Forsgren – Operations Manager		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility not preventing residents from becoming intoxicated while in care.
Resident threatened other residents in care with a knife.
Knives are accessible to residents in care.
Facility is not providing a safe environment for residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Michael Forsgren (Operations Manager) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of resident and staff rosters, interviewed Operations Manager, Resident 2 - Resident 7 (R2 - R7), Staff 1 (S1), and attempted to interview R1 via phone. LPA also obtained copies of R1's 30 day eviction notice, R1's 3 day eviction notice, R1's handbook and house rules with signature, Community Care Licensing (CCLD) approval letter for R1's 3 day eviction notice, R1's physician report, R1's progress notes, R1's unusual incident/injury reports and police report of 03/15/23 incident.

The investigation revealed the following: regarding the allegation "facility not preventing residents from becoming intoxicated while in care", it is alleged that excessive drinking in rooms that leads to public intoxication in the hallways, floors, dining and activity rooms and in the yards immediately surrounding the facility. (Continued to LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230320090047

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 03/28/2023

NARRATIVE

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Interview with the Operations Manager revealed that per the resident handbook and house rules alcoholic beverages are allowed in the facility, in moderation and must be enjoyed in the residents rooms and not permitted in the facility's common areas. He also stated that R1 has been the only resident not abiding by this house rule. R1 was drinking in the room, but not in moderation. However, the facility did their due diligence because per R1's progress report the Operations Manager reminded R1 of the house rules regarding alcohol on 01/30/23, 02/13/23 and 02/19/23. Due to R1 not abiding by the rules regarding alcohol, leaving the facility unattended, and not paying the monthly rent, the facility served R1 with a 30 day notice on 02/21/23. However, due to an incident involving R1 threatening other residents with a knife on 03/15/23, a 3 day eviction notice was issued on 03/21/23 and on 03/22/23 R1 was moved to a medical clinic. R2 through R7 could not corroborate the allegation and stated that R1 was the only resident not abiding by the house rules, but the facility has already evicted R1. R1 also could not corroborate the allegation and stated that R1 followed all house rules.

Regarding the allegation "resident threatened other residents in care with a knife", it is alleged that a recent incident required the assistance of 8 police officers and ambulances. A resident threatened other residents with a large fixed blade knife. Per interviews and documents reviewed, on 03/15/23 around 9pm R1 pulled a knife on R3 - R6. In the altercation R1 was the only one that sustained injuries. The police were called and a police report was made, but the police did not arrest R1 due to being on a wheelchair. R1 was taken to the hospital and released back to the facility on 03/16/23 at 5:30pm. Operations Manager tried to have R1's social worker relocate R1 to another facility instead of being brought back to the facility. However, no other place was available. Operations Manager reported the incident on 03/16/23 to Community Care Licensing (CCLD) and submitted a 3 day eviction notice for approval and served R1 with the notice pending CCLD approval. On 03/20/23, CCLD approved the notice and the Operations Manager served R1 with an official 3 day eviction notice on 03/21/23. On 03/22/23, R1 was moved out of the facility to a medical clinic. Interviewed with R1 revealed that R1 bought the knife at a local 99 cents. R2 through R7 confirmed that this incident occurred and it is an isolated incident. Although this allegation did occurred, the facility did their due diligence by trying to have R1's social worker relocate R1, reporting to CCLD and seeking a 3 day eviction notice.

(Continued to LIC 9099C)

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230320090047

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 03/28/2023

NARRATIVE

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Regarding the allegation "knives are accessible to residents in care", it is alleged that residents have access to knives. Interview with Operations Manager and staff revealed that all facility's knives are kept inaccessible to residents in the kitchen. The door leading to the kitchen is locked and no residents are allowed to enter the kitchen. All residents interviewed could not corroborate the allegation and confirmed the Operations Manager statement. During today's visit, theLPA observed a locked kitchen door and knives are kept in the kitchen. R1 stated that the knife that R1 had on 03/15/23 was bought by R1 at a local 99 cents and R1 did not let the facility know about this knife. Per R1's physician report, R1 cannot leave the facility unassisted and facility has made R1 aware of this. However R1 has refused to listen and has left the facility unassisted. R1's progress notes show that facility spoke to R1 about this issue on 02/07/23, 02/11/23 and 02/17/23. This is one of the issues that let to the 30 day eviction notice served on 02/21/23. R1 stated that R1 is fully capable of leaving the facility unattended despite what the physician report states.

Regarding the allegation "facility is not providing a safe environment for residents in care", it is alleged that there is a group of men who live at this facility (they also recently moved in) who get drunk in the afternoon and have engaged in "multiple" fights. Fights have occurred in hallways, the dining room, and outside during the last month. Operations Manager and staff denied this allegation, and stated the only fight that has occurred within the last month was the incident that occurred on 03/15/23 between R1 and R3 through R6. It was an isolated incident. All residents interviewed could not corroborate this allegation and stated that this is a safe facility, and that what occurred on 03/15/23 was an isolated incident.

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

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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