198603162-9-5-2023-28-AS-RORN-CVLM3V-20230912091544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 09/05/2023
Date Signed: 09/05/2023 05:12:58 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
04/14/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220414132650

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: 75	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Administrator Michael Forsgren		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility administering medications that are no longer prescribed to the resident.
Facility did not ensure that resident's current prescribed medications were being ordered

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 Administrator Michael Forsgren and the purpose of the visit was discussed.

Initial visit was conducted on 4/19/22 and consisted of the following: LPA Villalobos obtained resident and staff roster, reviewed Resident#1's (R1) file and obtained copies of documents related to their file. LPA interviews Staff #1-#3 (S1-S3).

On Todays visit, LPA Villalobos interviewed Staff #4-#5 (S4-S5) and Residents #2-#6 (R2-R6). LPA was unable to interview R1 as R1 is no longer in the facility. LPA reviewed R1's file as well as obtained copies of R1's medication records. LPA reviewed medications for residents #2-#6. The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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-20220414132650

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: 09/05/2023

NARRATIVE

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In regards to the allegation "Facility administering medications that are no longer prescribed to the resident." it was alleged that the facility was administering medication to R1 that was no longer prescribed. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. LPA reviewed R1's medication records from January 2022 - March 2022 and did not observe discharged medications being marked as being provided to R1. LPA was provided with medication orders to R1's pharmacy and the medications listed were also listed on R1's medications records. Interviews did not show that there are discharged medications being provided to R1. LPA did not observe R1's medications as R1 is no longer a resident and their medications are not available for review. Interviews did not state any staff were providing R1 with medications no longer prescribed to them. Based on the interviews conducted, observations and files reviewed, there was not enough supportive evidence to concur with the reported 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 "Facility did not ensure that resident's current prescribed medications were being ordered" it was alleged that R1 received new medication orders on 2/24/22 and they were not being ordered by the facility. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. Interviews state that as R1 was on Hospice care, the medications were being ordered by the hospice agency at the time. The facility kept an updated medication record for R1 which was provided to LPA. LPA received a medication order for R1s medications dated 2/24/22 and the medications ordered were continuation of medications in R1's medications chart at the time. LPA observed facility notes in R1's medications log that shows the Hospice Agency was filling orders for R1's medications. Interviews with current staff state that it is procedure to assist hospice agencies when needed in receiving and ordering any residents medications, but hospice agencies will usually fill and order prescribed medications themselves. The lists of medications are then provided to the facility who will ensure residents receive their medications as prescribed. LPA was not provided with proof that the facility was not ensuring medications were being ordered. Based on the interviews conducted, observations and files reviewed, there was not enough supportive evidence to concur with the reported 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.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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