198603162-10-2-2023-28-AS-RORN-CWPLK6-20231017084902

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 10/02/2023
Date Signed: 10/02/2023 05:08:19 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/28/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230928134929

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	FORSGREN, MICHAEL		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 79	DATE:	10/02/2023
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Itzayana (Itzy) Barba Aguirre		TIME COMPLETED:	05:14 PM

ALLEGATION(S):

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Facility smells of urine.
Staff serves resident cold meal(s).

INVESTIGATION FINDINGS:

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Licensing Program analyst (LPA) Alberto Lopez made unannounced 10-day visit to investigate the above allegations. LPA met with Executive Director Itzayana (Itzy) Barba Aguirre and discussed the purpose of the visit.

The investigation consisted of taking a tour of the facility including the kitchen, dining room and TV rooms on the first and second floor. LPA reviewed and obtained copy of staff, facility rosters and Facility Admiission Agrement and interviewed six staff (S#1-S#6) and nine residents (R#1-R#9).

The investigation revealed of the following:
Allegation Facility smells of urine. It is alleged that facility common area such as dining room and TV rooms has bad order of urine and or body odor.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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-20230928134929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 10/02/2023

NARRATIVE

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LPA interviewed 6 staff and 5 of 6 staff collaborated the allegation. S1 has only been here a week and could not comment on allegations and stated no complaints had been brought to her attention as of today. 5 staff all stated that some residents refuse showers and/or do not let the staff know if they need a change of diaper which is the source of the odor. S6 stated that residents that require a change of diaper are check every hour and are told that refusing impinges on other residents rights. 4 of 6 staff stated that even after residents leave their chairs, and after staff clean and disinfects, the odor remains in the dining room and TV rooms.

Allegation: Staff serves resident cold meal(s). it is alleged that the facility servers meals undercooked and cold. LPA interviewed six staff (S#1-S#6) and nine Residents (R#1-R#9). 4 of 6 staff interviewed stated that food is served hot but when served onto the cold plates it losses heat rapidly. 8 of 9 residents collaborated the allegation that food is served cold most of the time.9 of 9 residents could not collaborate the allegation that food is undercooked. Some staff stated they will reheat food for residents in micro-wave when asked. Some staff stated that 3 ovens in the kitchen are in disrepair and staff had used the ovens previously to warm the plates. Several staff stated that facility does not own a dish warmer that would solve the issue of food being served cold.

Based on observation, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies cited according to California Code of Regulations, Title 22. See LIC 9099D.

NOTE: Please see Case Management - Deficiencies report.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230928134929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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: 10/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 10/09/2023 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	Managed Incontinence. Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidence by:	1 2 3 4 5 6 7	The Executive Director will submit a written plan on how the facility will address the issue of keeping the clients clean and dry and the facility free of odors from incontinence and send it to LPA by POC date.
	8 9 10 11 12 13 14	5 of 6 staff and 8 of 9 residents collaborated the allegation that there is a odor of urine in the common dining area and kitchen area on most days.	8 9 10 11 12 13 14
Deficiency Dismissed Type B 10/09/2023 Section Cited CCR 97555(a)	1 2 3 4 5 6 7	General Food Service Requirements: The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be served in a safe and healthful manner. This requirement was not met as evidence by,	1 2 3 4 5 6 7	The Executive Director shall provide a written meal service plan detailing how all meals will be served to the residents hot in a healthful manner. The required plan shall be submitted to CCL by the POC Date.
	8 9 10 11 12 13 14	8 of 9 of the residents state, there was occasions when the meals were served to them cold; meaning, it was served to them in a way that was not in a healthful manner. 4 of six staff stated the they place the food while hot on the plates but the cold plates absorb the heat and the food arrives cold.	8 9 10 11 12 13 14

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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC9099 (FAS) - (06/04)

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