198603162-5-3-2023-28-AS-RORN-CRXV9P-20230518161441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/02/2023
Date Signed: 05/03/2023 10:04:35 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
04/27/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230427130936

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:	05/02/2023
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Wellness Director Sherrie Similton		TIME COMPLETED:	03:19 PM

ALLEGATION(S):

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Staff are not feeding resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint investigation visit for the allegation above. LPA met with Wellness Director Sherrie Similton and the purpose of the visit was discussed.

On todays visit, LPA interviewed Staff #1-#5 (S1-S5) and residents #1-#6 (R1-R6). LPA reviewed food menu for weeks of January and April 2023. LPA reviewed toured the physical plant and observed the food supply. LPA collected copies of the resident and staff roster. LPA reviewed and collected copies of documents from R1's file. The investigation revealed the following:

In regards to the allegation "Staff are not feeding resident in care." it was alleged that R1 has not received meals in the facility since Easter 2023 (4/9/23). (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation.

CONITUNED ON LIC9099-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: 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)

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Control Number 28-AS-20230427130936

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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Interviews show that R1 eats meals in the facility on occasion but will choose to eat meals in their room with food and snacks that R1 purchases themself. Interviews do not show that R1 is denied meals or not offered meals in the facility. File review shows that R1 is provided a special diet due to health reasons and all staff interviewed are aware of it. LPA observed the food supply and observed residents eating sufficient meal portions for lunch. 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 Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (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)

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