198603162-10-24-2023-28-AS-RORN-D4UN3L-20240501100631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:25:13 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
10/20/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231020093532

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: 77	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administrator Itzayana (Itzy) Barba		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff did not assist resident with obtaining medical care.
Licensee does not ensure staff dispensing medication to residents are appropriately trained.
Staff did not dispense medication to resident as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint investigation visit for the allegation(s) above. LPA met with Administrator Itzy Barba and the purpose of the visit was discussed.

On todays visit, LPA conducted the following: Toured the physical plant, Interviewed Staff #1-#7 (S1-S7) , interviewed residents #1-#6 (R1-R6), reviewed resident file for R1-R2, collected documents from R1 and R2's files, reviewed and collected documents from S1's file , and collected a copies of the staff and resident roster. The investigation revealed the following:

In regards to the allegation "Staff did not assist resident with obtaining medical care." it was alleged that the facility staff do not assist with scheduling doctor appointments and transportation for R1. (7) of (7) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. Interviews show that there was a lack of communication between the facility and R1's relative, who has Power of Attorney for Healthcare of R1....
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: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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-20231020093532

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: 10/24/2023

NARRATIVE

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There was a lack of confirmation regarding the doctor appointment schedule for R1 on 10/19/23, but the appointment and transportation were set and provided. Interviews showed that R1 was able to make their appointment and were transported by the facility. Interview with other residents of the facility do not show that there is no assistance with obtaining medical care. Based on interviews, files reviewed, and observations conducted, 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 "Licensee does not ensure staff dispensing medication to residents are appropriately trained" it is alleged that S1 is not appropriately trained to dispense medications. (7) of (7) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. LPA reviewed S1's file and observed required medication management training along with required hours to have been completed. Interviews with staff shows the staff is aware of the duties and tasks of staff who dispense medications. LPA was not provided with proof that S1 is not appropriately trained to dispense medications. Based on interviews, files reviewed, and observations conducted, 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 "Staff did not dispense medication to resident as prescribed" it is alleged that staff did not provide R2 with their blood pressure medication for a week. (7) of (7) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. Interviews do not show that staff have refused to provide R2 with their medications. Interview with R2 stated that it was only 1 day that was missed and it was on 10/19/23. Staff interviewed denied that medications was not provided to R2 on 10/19/23. LPA reviewed R2's medication record and observed that it was logged that R2 received their prescribed medications on 10/19/23. Based on interviews, files reviewed, and observations conducted, 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: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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