198603162-12-12-2023-28-AS-RORN-CZSSLE-20240124125807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:06:21 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
08/30/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220830111314

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: 75	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Business/ HR Manager Lizbeth Acuna		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Administrator Speaks to residents in a disrespectful manner
Facility staff did not perform room checks as needed
Facility did not address bed bugs in resident room
Residents not afforded comfortable accommodations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation above. LPA met with Business/ HR Manager Lizbeth Acuna and the purpose of the visit was discussed.

Initial visit conducted on 9/7/22 consisted of the following: LPA toured the physical plant. LPA requested a copy of the resident/staff roster. LPA interviewed Staff #1-#5 (S1-S5), LPA collected the following documents from Resident #1's (R1) file; physicians report, identification and emergency information, needs and services plan and Medication record for July/August 2022. LPA also collected documents from S2's staff file.

As of todays visit. LPA has interviewed resident #1-#5 (R1-R5) and Staff #6-#7 (S6-S7). The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20220830111314

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: 12/12/2023

NARRATIVE

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In regards to the allegation "Administrator Speaks to residents in a disrespectful manner" it was alleged that S1 speaks to residents inappropriately. (7) of (7) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. (1) of (5) residents interviewed stated that S1 has spoken to them disrespectfully when they were greeting S1 and S1 spoke rude comments under their breath. S1 denied ever speaking disrespectfully to any residents in care. LPA was not provided proof that S1 speaks to residents in a disrespectful manner. LPA did not observe S1 speak disrespectfully to and about residents in care. Based on observation, interviews and file review; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

In regards to the allegation "Facility staff did not perform room checks as needed" it was alleged that the facility staff did not conduct room checks for R1 between 7/12/22-7/16/22. (7) of (7) staff interviewed denied the allegation. (4) of (5) Residents could not corroborate the allegation. Interviews with staff state that R1 is not on a plan that requires wellness checks throughout the day. Staff stated that rooms are visited everyday by housekeeping staff and room checks are done when residents are not observed to eat meals or get their medications. Interviews with staff show that R1 was leaving their room for meals and was receiving medications as scheduled. LPA did not observe documentation or reports stating that R1 required wellness checks from staff or was not able to get out of bed for the dates provided. Based on observation, interviews and file review; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

In regards to the allegation "Facility did not address bed bugs in resident room" it was alleged that R1 had bed bugs in January 2021 and staff did not address the issue in a timely manner. (7) of (7) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. Interviews showed that R1 had bed bugs in their room in January of 2021 and were temporarily relocated rooms while their room received treatment. File review shows that the facility received pest control services for R1's room on 1/5/2021. Interviews could not inform LPA on when the facility was aware of the bed bugs up to the time that the pest control was provided as the staff who would have been in charge no longer work here. Based on observation, interviews and file review; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Continued on LIC 9099-C

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220830111314

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: 12/12/2023

NARRATIVE

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In regards to the allegation "Residents not afforded comfortable accommodations" it was alleged the R1 was relocated to a room with no blankets, no sheets, no pillowcase, no towels and no basic toiletries in January 2021 while their room was treated for bed bugs. (7) of (7) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. S3 interview stated that they personally provided R1 with blankets, towels, and hygiene products while they were temporarily relocated rooms. All rooms in the facility have their own bathrooms for residents to use so R1 was not left without any accommodations. LPA was not provided proof that staff left R1 without their basic necessities or neglected assistance when needed. Based on observation, interviews and file review; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit Interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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