198603162-4-13-2023-28-AS-RORN-CRPURX-20230510154927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 04/13/2023
Date Signed: 04/13/2023 01:04:15 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
04/10/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230410112405

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: 65	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Operations Manager Michael Forsgren		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident's medications are being stolen by staff while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an initial complaint investigation visit for the allegation listed above. LPA met with Operations Manager Michael Forsgren and the purpose of the visit was discussed.
On todays visit, LPA interviewed Staff #1-#2 (S1-S2) and interviewed Operations Manager from 9:15 AM to 10:00 AM
Resident's R2-R7 were interviewed from 10:00 AM to 11:00 AM.
LPA collected a copy of the staff and resident roster.
LPA reviewed Resident R 1's file and facility submitted the face sheet, needs and services plan, physicians report, and admissions agreement.
In regards to the allegation Resident's medications are being stolen by staff while in care, based on interviews conducted and information gathered Resident's 2-7 who were interviewed stated that they are administered medication 3x a day and it has gone smoothly all the time. They stated they have not missed any medications and staff are great and will always find them if they are not there and ensure they don't miss any dosage..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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-20230410112405

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: 04/13/2023

NARRATIVE

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All interviewed stated no pills have ever been stolen and are never missing.
Staff interviewed stated that Resident R 1 self administers medication now and when the facility did administer there have not been any times that medication has been taken or stolen. Said they have documented on the Mar's Log all medication given to R 1.
Stated that there has been no law enforcement or FBI who have come to the facility to investigate any allegations regarding R1's medication.
Review of medication and Mar's Log from November 2022 thru January 2023 revealed that doses were administered to R 1 and checked off on the dates given. When the PRN Oxycodone was requested by R 1 it was checked off on the dates administered.

Although the allegation 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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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