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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/02/2023
Date Signed: 05/03/2023 10:05:10 AM

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
01/24/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230124104621
FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:ATEAIAN, KIMIAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 65DATE:
05/02/2023
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Wellness Director Sherrie SimiltonTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff mishandled a resident's medications while in care
Staff did not meet a resident's dietary needs while in care
Staff did not provide adequate care and supervision to a resident while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation(s) above. LPA met with Wellness Director Sherrie Similton and the purpose of the visit was discussed.

Initial visit on 1/25/23 consisted of the following: LPA interviewed Staff #1-#2 (S1-S2) and Residents #2-#5 (R2-R5). 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 facesheet, needs and services plan, medication record, and any related facility notes. LPA was unable to interview R1 as R1 was not available during the visit.

On todays visit, LPA interviewed Staff #3-#6 (S3-S6) and resident #1(R1) and resident #6 (R6). LPA reviewed food menu for weeks of January and April 2023. The investigation revealed the following:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
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 2
Control Number 28-AS-20230124104621
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: 05/02/2023
NARRATIVE
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In regards to the allegation "Staff mishandled a resident's medications while in care" it was alleged that R1 did not receive their medication for the month of January and weeks of December 2022. (6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 received their medication as prescribed for all months R1 received medicine management from the staff. LPA reviewed the medication records and observed R1 to have been receiving their medication as prescribed. Interview with R1 shows that R1 wanted to manage their own medication and as of 2/6/23, under order from physician, R1 has a safe to store and manage their own medication. LPA was not provided proof that staff did not provide R1 their medication prior to 2/6/23. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation; 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.

In regards to the allegation "Staff did not meet a resident's dietary needs while in care" it was alleged that there was no protein being provided in residents meals. (6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews show that protein is provided in multiple meals throughout the day to residents in care. Interviews also stated that residents can fill out a meal substitution form where they can request specific meals if they do not want what is on the menu. LPA observed the food supply to have protein based food. LPA reviewed the facilities meal schedules for various weeks and observed each day to have protein on menu. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation; 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.

In regards to the allegation "Staff did not provide adequate care and supervision to a resident while in care" it was alleged that staff abuse and neglect R6. (6) of (6) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interview with R6 denies any abuse and neglect from staff. Interviews do not show that staff abuse and neglect R6. LPA did not observe any documentation on file of R6 being abused or neglected. LPA was not provided with proof that staff abuse or neglect R6. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the allegation; 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 conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2