198603162-1-5-2022-28-AS-FFIS-CT2SJJ-20230622135515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 01/05/2022
Date Signed: 01/05/2022 03:46:24 PM

Substantiated

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
12/29/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211229150408

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: 56	DATE:	01/05/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Staff Christina Gonzalez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident's funds are being stolen.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Sophia Chan. Purpose of the visit was discussed.

On Todays visit , LPA interviewed Staff #2-#3 (S2-S3) between 10am-10:45am and Residents #1-#2 (R1-R2) from 1pm-1:45pm. LPA toured the physical plant and room #121 from 12:30pm-1pm. LPA reviewed and collected copies of R1's resident file and S1's Staff file between 10:45am-12:30pm. LPA also recieved a copy of the staff and resident roster. S1 was not available for interview as S1 no longer works in the facility.

The investigation revealed the following, in regards to the allegation "Resident's funds are being stolen", it was alleged that S1 was responsible for unusual spending in R1s bank account while S1 was responsible for R1's finances...

Continued on LIC 9099-C

Substantiated

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: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

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-20211229150408

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: 01/05/2022

NARRATIVE

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Interviews with staff show that an audit was conducted by the facility that revealed the unusual spending in R1's bank account in 2021. When approached with questions, S1 resigned from the facility. Interviews with R1 show that purchases were made on R1's account by S1 without R1's knowledge. LPA reviewed R1's file and did not find documentation authorizing the use of her debit card for purchases. File review shows that R1 is self responsible and that the facility does not manager R1's finances, yet S1 was able to access R1's bank account. Based on interviews conducted and files reviewed, the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. California Code of Regulations, Title 22, citations are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Staff Christina, and a hard copy was provided. Appeal rights were discussed and provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211229150408

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/05/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/21/2022 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions... This deficiency was evidenced by the following:	1 2 3 4 5 6 7	Administrator had notified ombudsman via SOC 341 but will need to porivide a copy to Licensing. S1 was also removed as staff. Administrator conduct training for staff on Resident Personal Rights and provide LPA with proof by POC due date.
	8 9 10 11 12 13 14	Resident #1 (R1) had been financial abused by Staff #1 (S1) leading to non-authourized purchases made to R1's bank account. This poses a potential health and safety risk to residents under care and supervision.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022

LIC9099 (FAS) - (06/04)

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