<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:20:02 PM

Substantiated


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 LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:ATEAIAN, KIMIAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 70DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Business/ HR Manager Lizbeth AcunaTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have a full time Activity Director
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation(s) above. LPA met with Busniess/ 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 physcial 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. Subsequent visit conducted on 12/12/23 consisted of the following: LPA interviewed Staff #6-#7 (S6-S7). As of todays visit. LPA has also interviewed Staff #8 (S8). Staff #9 (S9) was unavailable for interview LPA reviewed and collected documents from S1,S3-S5's files. The investigation revealed the following:

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 6
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 LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:ATEAIAN, KIMIAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 73DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Business/ HR Manager Lizbeth AcunaTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident unsupervised after fall
Facility is not adequately staffed
Staff are not qualified to perform duties
Staff mismanaged residents medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegations above. LPA met with Busniess/ 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 physcial 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. Subsequent visit conducted on 12/12/23 consisted of the following: LPA interviewed Staff #6-#7 (S6-S7). As of todays visit, LPA has interviewed resident #1-#5 (R1-R5) andStaff #8 (S8). Staff #9 (S9) was unavailable for interview LPA reviewed and collected documents from S1,S3-S5's files. The investigation revealed the following:

Continue on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 01/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation "Staff left resident unsupervised after fall" it is alleged that R1 had a fall on 7/24/22 and staff did not stay with R1 until paramedics arrived. (8) of (8) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. Staff interviews state that staff are to assess to residents when there are any falls and based on the situation, call paramedics when necessary. Interviews show that it was staff S9 who assisted R1 when they fell and called the paramedics after assessing R1. LPA was unable to interview S9 to determine whether they had left R1 unsupervised. 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 is not adequately staffed" it is alleged that there are not enough staff at the facility to meet the residents needs. (8) of (8) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. Interviews show that all residents are having their needs met in the facility. There is a phone application used by the facility caregivers that notes which residents in the facility need assistance based on their needs and services plan throughout each day. The staff will check off each task completed for each resident and no one is left unattended. Interviews state that medication aide staff and administration staff will assist when necessary to complete all tasks for the residents. 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 "Staff are not qualified to perform duties" is is alleged facility staff do not have basic required training's for their positions regarding medical issues. (8) of (8) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. Interviews state that not all staff handle resident medications. That duty is assigned to trained medication aides and the Wellness Director. File review for medication aides show that staff have completed medication management training's as well as first aid /cpr trainings required of the position. All staff providing direct care to residents are also trained in resident wellness and recognizing signs of dementia. 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 FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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: 01/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation "Staff mismanaged residents medications" it is alleged that staff provided R1 the improper combination of medication. (8) of (8) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. LPA reviewed R1s medication records and did not observe errors. Interviews with staff state that doctors or psychiatrists will review resident medications and make the orders for any adjustments. The staff will collect the medication from the pharmacies and administer medications as prescribed to residents in care. LPA also observed doctor orders on file for medications observed. 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 FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6
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: 01/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation "Facility does not have a full time Activity Director" it is alleged the facility went months without a full time staff running the activities and social gathering. Interviews show that between the months of March 2022-July 2022 there was no full time activity director and the facility activities and social gatherings were being conducted by S2 whos position was not as a full time activity director. File review shows the S2 was given the title and hired as the full time Activities Coordinator on 7/5/2022 while the previous staff had left the facility in March 2022. This shows that as a facility, licensed for 50+ residents, failed to have a full-time staff who's responsibility is to organize, conduct and evaluate planned activities. Based on LPA interviews conducted and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Deficiencies cited under California Code of Regulations Title 22. See 9099D. Exit interview conducted and copy of the report with appeal rights was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/12/2024
Section Cited
CCR
87219(f)
1
2
3
4
5
6
7
87219. Planned Activities(f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities...
This was not met as evidenced by
1
2
3
4
5
6
7
Facility currently has a qualified full time activity coordinator. Deficiency cleared at the time of this visit.
8
9
10
11
12
13
14
Facility went about 4 months without a full time activity coordinator for the residents, which poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6