198603162-1-9-2024-28-AS-RORN-CZDVAB-20240111151541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:13:05 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
03/22/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220322090350

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: 70	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Itzayana Barba Aguirre, Executive director/Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained an injury from a fall while in care.
Staff did not address a resident's diabetic needs while in care.
Staff are using a resident's room for work breaks.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met Itzayana Barba Aguirre, Administrator, and explained the purpose of today's visit.

On 03/30/22, LPA Tao conducted the initial investigation visit. LPA obtained staff/resident roster, and resident #1’s (R1) facility files. LPA Tao interviewed staff and residents. Due to insufficient information, it needed a further investigation.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #5 (S5); attempted to interview resident#1 (R1) but R1 was deceased on 4/22/23; interviews of residents from Resident#2 (R2) through Resident #8 (R8); reviewed resident#1’s record reviews, and a facility tour.
LPA obtained copies of the staff/ resident Rosters; and resident files for Resident #1 (R1) with relevant information.
(-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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 3

Control Number 28-AS-20220322090350

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: 01/09/2024

NARRATIVE

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The investigation revealed the following:

In regards to the allegation of: resident sustained an injury from a fall while in care, it was alleged that the resident fell and injured when getting up from resident’s own wheelchair at the facility. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. One (1) out of eight (8) residents was deceased and unable to be interviewed. Resident interviews revealed that they did not fall from their wheelchair or staff would assist them right away when they fell. All staff interviewed denied the allegation. Per staff interviews, staff stated the resident got agitated and fell off from resident’s own wheelchair when resident tried to get up by oneself. Per record reviews, it indicated that staff was trained to provide care to resident who had fall risk. Staff assisted resident and provided care after the fall occurred. Resident had plan of care in place. Thus, there was not preponderance of evidence to show resident sustained an injury from a fall due to lack of care.

In regards to the allegation of: staff did not address a resident's diabetic needs while in care, it was alleged that staff failed to check resident's glucose by using Glucose meter. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff provided residents with diabetic medication and had the LVNs or their own health care nurses monitored their glucose level. Meals were modified per doctors' prescription for diabetic residents. All staff interviewed denied the allegation. Per staff interviews, staff stated only LVNs allowed to administer glucose check using glucose meter. Other staff were not qualified to administer residents’ glucose tests. Per record reviews, resident was on hospice care. No doctor prescription to order blood test on resident. As a result, there was not preponderance of evidence to show staff failed to address diabetic needs.

In regards to the allegation of: staff are using a resident's room for work breaks, it was alleged that staff used resident’s room as a break room. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff did not use their room as staff's break room. All staff interviewed denied the allegation. Per staff interviews, staff stated they had their staff break room and did not need to use resident’s room for taking breaks. Per observation, staff took breaks in their staff break room. Therefore, staff did not use resident's room for work breaks.

(-continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220322090350

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: 01/09/2024

NARRATIVE

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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.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator. A hard copy of this reports were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

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