198603162-12-7-2023-28-AS-FFIS-CYYTF8-20231229134108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:00:26 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
11/27/2023 and conducted by Evaluator Ashley Calderon

COMPLAINT CONTROL NUMBER: 28-AS-20231127095511

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: 74	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:			TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff do not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced initial 10 days complaint visit. LPA met with Staff/ Receptionist/ Michelle Bascom and shortly after met with Wellness Director/ Kathleen McDonald and discussed the purpose of today's visit.

The investigation consisted of the following: On today's date, LPA interviewed Staff #1 - Staff #3, Staff #5 (S1-S4, and S5), attempt to interview Staff #4 via telephonically and interviewed Resident #2- Resident #7 (R2-R9), attempt interview Resident #1 (R1) via telephonically and obtained copy of staff and residents roster, R1's Face sheet, recent incident reports and Physician report. LPA collected training related to complaint topic regarding dignity and respect. LPA toured common areas and facility outside and inside premises.

Continuation 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231127095511

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: 12/07/2023

NARRATIVE

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The investigation revealed of the following: Allegation 'Staff do not treat resident with dignity and respect. Interviews LPA conducted with Staff revealed (3) out of (4) staff denied the above allegation and informed LPA that Staff treat residents with dignity and respect and (4) out of (4) staff stated receiving training on how to treat, respect and communicate with residents in care. Interviews with residents (4) out of (6) residents informed LPA that the facility staff treats them and other residents nice and treat them with dignity and respect. LPA reviewed training's for S2-S5 related to topics of dignity and respect like Employee Handbooks/ duties and responsibilities, Compliance, Direct Care and Sexual Harassment. LPA observed staff and residents interactions during time of visit and staff were observed treating residents with dignity and respect.

Based on statements gathered from interviews conducted with staff and residents, observations, record review, 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 held. A copy of the report will be emailed to Wellness Director Kathleen McDonald.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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