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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 10/02/2023
Date Signed: 10/13/2023 08:16:52 AM

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
COMPLAINT CONTROL NUMBER: 28-AS-20230928134929
FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:FORSGREN, MICHAELFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 79DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Itzayana (Itzy) Barba AguirreTIME COMPLETED:
05:14 PM
ALLEGATION(S):
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9
Staff serves resident cold meal(s).
INVESTIGATION FINDINGS:
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13
This report is written to correct the citation from 97555(a) to 87555(a). Nothing else has changed.
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.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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-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)
Type B
10/09/2023
Section Cited
CCR
87625(b)3)
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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:
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2
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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 dat
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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.
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Type B
10/09/2023
Section Cited
CCR
87555(a)
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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,
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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.
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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.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2