198603162-5-5-2023-28-AS-FFIS-CRN269-20230508170646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/27/2023
Date Signed: 05/05/2023 12:54:58 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
09/19/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220919170436

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:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Business Office Manager Diana Marquez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are not communicating with resident's representative in a timely manner.
Facility staff forced resident/representative to sign inappropriate document(s) while in care.
Facility staff are not protecting resident(s) from other resident in care.

INVESTIGATION FINDINGS:

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***This report supersedes the original report created on 3/27/2023. Reason for supersede is to ensure report accurately refers to residents interviewed. Findings have not changed.***

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegations listed above. During today’s visit, LPA met with Business Office Manager Diana Marquez and explained the purpose of today's visit.

Initial visit was conducted by LPA Tao and consisted of the following: LPA Tao interviewed staff#1 (S1) and review records. LPA obtained copies of resident roster, staff roster, resident#1's and resident#2's file.
On Todays visit, LPA Villalobos interviewed Staff #2-6 (S2-S6) and Residents #1-6 (R1-R6). S1 no longer works in the facility and was unable to be contacted for interview. The investigation revealed the following:

In regards to the allegation "Facility staff are not communicating with resident's representative in a timely manner." it was alleged that the facility staff are not responding and/or ignoring communication with R1's responsible party.... (CONITNUED 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: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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-20220919170436

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: 03/27/2023

NARRATIVE

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***This report supersedes the original report created on 3/27/2023. Reason for supersede is to ensure report accurately refers to residents interviewed. Findings have not changed.***

(6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1's responsible party contacted the facility multiple times to speak with the management. Specific dates were not provided to LPA. Interviews with staff show that due to the nature of questions asked by R1's responsible party, the administrator or facilities legal department would be the ones to address R1's responsible party. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff forced resident/representative to sign inappropriate document(s) while in care" it was alleged that S1 attempted to force R1 to sign new house rules and level of care plan . (6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff deny forcing any residents in care to sign documents for any reason. Interview with R1 stated they denied signing any forms provided by S1. Review of R1's file did not show any documents that R1 was forced to sign. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

In regards to the allegation "Facility staff are not protecting resident(s) from other resident in care." it was alleged that staff was not protecting residents from R2. (6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews stated that R2 has recently become disruptive and aggressive while in living in the facility. Interviews with residents stated that anytime R2 had an incident, staff was able to separate R2 immediately and address the situation. File review shows documentation of incidents dated 9/3/22 and 9/7/22 involving R2 were reported and completed timely. Cops were called on both incidents but R2 was not arrested. File review shows that R2 was also served an eviction notice on 9/19/22 for violating facility rules. Review of R2's file did not show that they needed a 1 on 1 or 24/hr supervision. Although the allegations may have happened or are 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 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: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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