198603162-1-12-2024-28-AS-FFIS-D29RMB-20240208120826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 01/10/2024
Date Signed: 01/12/2024 05:03:36 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
03/17/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220317104159

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:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kathleen McDonald, Wellness Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not accept resident's prescribed medication.
Staff locked resident's wheelchair.
Facility did not ensure that resident was properly dressed.
Resident was left in dirty clothing.
Facility did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met with Kathleen McDonald, Wellness Director, and explained the purpose of today's visit.

On 03/24/22, LPA Tao conducted the initial investigation visit. LPA obtained staff/resident roster, and resident #1’s (R1) facility files. LPA Tao interviewed the former administrator 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; interviews of residents from Resident#2 (R2) through Resident #8 (R8); reviewed resident#1’s record reviews, and a facility tour.

(-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-20220317104159

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: 01/10/2024

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

LPA obtained copies of the staff/ resident rosters; and resident files for Resident #1 (R1) with relevant information.

The investigation revealed the following:

In regard to: facility did not accept resident's prescribed medication, it was alleged that staff did not take a glucose meter from resident's responsible party. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff administer residents’ medication as prescribed including their diabetic care needs. All staff interviewed denied the allegation. Staff interviews revealed only LVNs or medical professionals were allowed to administer glucose check using glucose meter if it was prescribed by physician orders. Per record reviews, the resident was on hospice care. There was no prescription or doctor's order to instruct the facility to conduct glucose test or use glucose meter on the resident. As a result, facility did not have physician order on administering glucose test or accepting glucose meter.

In regard to: staff locked resident's wheelchair, it was alleged that the wheels on the resident’s wheelchair were locked while resident was in resident's room. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that their wheelchairs were locked for safety purposes, such as dining in dining room. Staff would unlock residents' wheelchairs after meals. All staff interviewed denied the allegation. Per staff interviews, it stated staff were not allowed to lock the wheels of residents' wheelchairs, unless for safety reasons. Per record reviews, it indicated that resident was able to unlock the wheels. Per LPA's observation, the residents in wheelchairs were able to move around and staff would assist residents if their wheelchairs got stuck. Thus, there was not preponderance of evidence to show staff locked resident's wheelchair.

In regard to: facility did not ensure that resident was properly dressed, it was alleged that staff did not check on resident#1 (R1) to ensure resident was clothed appropriately. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff dressed residents every morning and clothed them properly. All staff interviewed denied the allegation. Staff was instructed to check and change R1’s diaper every two (2) hours which staff would clean and dress R1 every two (2) hours. Per LPA’s observation, residents were dressed properly. Therefore, staff dressed residents decently. (-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: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220317104159

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: 01/10/2024

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 regard to: resident was left in dirty clothing, it was alleged that resident’s clothes was full of food. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff would clean them after meals if their clothes had food on. All staff interviewed denied the allegation. Staff interviews revealed staff would change residents’ clothes if they got food on their clothes. Some residents may have bibs on while eating. As mentioned above, staff was instructed to check on R1 every two (2) hours which staff would clean and dress R1 every two (2) hours. Per LPA’s observation, residents looked clean. Therefore, staff did not leave residents in dirty clothing.

In regard to: facility did not safeguard resident's personal belongings, it was alleged that the facility stole resident#1 (R1)’s diapers. Seven (7) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff did not steal residents’ diapers supplies. All staff interviewed denied the allegation. Staff interviews revealed staff was instructed to change R1’s diaper every two (2) hours. By comparing the diaper supplies to the diaper usages, R1’s diaper’s usage matched with diaper supplies. Therefore, R1’s diaper supplies were used up by R1, not stolen by staff.

Although the allegations may have happened or is valid, there is not 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 Kathleen McDonald, Wellness Director. A hard copy of this reports was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3