198603162-4-18-2023-28-AS-RORN-CR8VXW-20230425165012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/18/2023
Date Signed: 04/18/2023 05:17:16 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
02/09/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230209175650

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: 65	DATE:	04/18/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Operations Manager Michael Forsgren		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are overmedicating a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint investigation visit for the allegation(s) listed above. LPA met with Operations Manager Michael Forsgren and the purpose of the visit was discussed.

Initial visit conducted on 2/14/23 involved the following: LPA interviewed Staff #1-#4 (S1-S4) and Resident #1-2 (R1-R2). LPA toured the physical plant of the facility and observed the food supply. LPA collected a copy of the staff and resident roster. LPA collected documents related Resident #1's (R1) File such as the face sheet, needs and services plan, medication record, and any related facility notes.

On Todays visit, LPA interviewed residents #3-#7 (R3-R7) and Staff #5 (S5). LPA unable to interview staff #6-7 (S6-S7) as they no longer work in the facility and were unavailable for interview. LPA also contacted and interviewed Nurse Practitioner (NP) for R1. The investigation revealed the following:

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: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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-20230209175650

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: 04/18/2023

NARRATIVE

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In regards to the allegation "Staff are overmedicating a resident in care." it was alleged that R1 was over medicated and in a coma like state for one week to two weeks starting 7/12/22, and the facility staff was aware but did not do anything about it. (5) of (5) Staff interviewed denied the allegation. (6) of (7) Residents interviewed could not corroborate the allegation. Interviews with staff do not show that R1 was observed to have been over medicated at any point while in the facility. Residents interviewed did not state to have seen R1 over medicated or aware of any residents being overmedicated. Review of medication records shows that R1 continued to take prescribed medications throughout the month of July 2022 up until they were taken to the hospital on 7/24/22 for a fall. R1 returned to the facility on 7/26 and later had a change in medication prescriptions. There are no notes showing that R1 was having adverse effects to their medication. Interviews with staff show they continued to follow physician orders regarding R1's medication as they must do. Interviews do not show R1 refusing medication. Interview with NP does not show that R1 had been in a coma like state or was over medicated by facility staff. Based on interviews, observations , and file reviews conducted; 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 held and a copy of the 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: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC9099 (FAS) - (06/04)

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