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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 08/15/2023
Date Signed: 08/16/2023 10:21:08 AM

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
02/07/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220207115219
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: 75DATE:
08/15/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Administrator Michael ForsgrenTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident fell while in care
Resident's sustained injuries while in care
Staff left resident in soiled diapers for extended period of time
Staff are not meeting resident's hygiene needs
Resident rooms are unsanitary
Staff are using resident's bathroom
Staff did not notify resident's authorized representative of incidents
Residents room is in disrepair
Staff are not ensuring resident has call bracelet on as required by admissions agreement
Staff are not providing adeqaute food service to resident's
Staff are not providing adequte laundry service to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPA met with administrator Michael Forsgren and the purpose of the visit was discussed.

Initial visit conducted on 2/16/22 consisted of the following: LPA Villalobos interviewed Staff #1-#7 (S1-S7) between 10:45am-1pm and 3:!5pm-3:45pm. LPA toured the facility and observed the food supply between 1pm-1:45pm. LPA reviewed resident #1 (R1) and resident #2's (R2) file between 2pm-3pm. LPA collected copies of R1 and R2's file. LPA also received a copy of the staff and resident roster.

Additionaly as of todays visit, LPA has interviewed Staff #8 (S8) and Residents #1-6 (R1-R6), and Hospice agency for R1. The Investigation revealed the following:

See 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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
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 5
Control Number 28-AS-20220207115219
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: 08/15/2023
NARRATIVE
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In regards to the allegation "Resident fell while in care" it was alleged that R2 fell in the facility and staff did not assist them. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews do not show that R2 has fallen anytime recently and needed to shout for help. Staff denied that they would refuse to assist any resident in care. File review did not show documentation of R2 having a fall resulting a cut on their forehead. R2 did not state they had a fall and needed to scream for help. Interviews with residents state that staff assist residents when they are in need. Based on interviews, file review, and observation; 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 "Resident's sustained injuries while in care" it was alleged that facility staff scratched R1 while moving them. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff deny having scratched R1 while assisted them in and out of bed or when assisting them with their grooming needs. LPA was not provided with proof that any staff had scratched R1. Files reviewed by LPA do not show that staff had scratched R1 as there are no notes documented regarding injuries while assisting resident. Based on interviews, file review, and observation; 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 left resident in soiled diapers for extended period of time" it was alleged that Staff were not changing R1 frequently as needed. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff state that staff changed R1 3-5 times a day as incontinence care was part of their service. Staff would not refuse or deny changing R1 but stated that there are many residents that require assistance and so staff could not always change R1 at the moments that R1's family requested. LPA reviewed R1s care plan and it does not specify a number of times R1 needs to be changed. LPA did not observe R1 left in soiled diapers during initial visit. Based on interviews, file review, and observation; 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

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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20220207115219
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: 08/15/2023
NARRATIVE
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In regards to the allegation "Staff are not meeting resident's hygiene needs" it was alleged that R1 was not given showers as needed. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. It was alleged that during a covid outbreak in the facility staff was not able to meet R1's showering needs. File review shows the facility had a covid outbreak from December 2021 - End of January 2022. During this time many staff and residents had covid. Staff interviewed stated that scheduling and assisting residents with their needs was still conducted and that R1 did receive the amount of showers as needed each week. R1's Service Plan states that R1 should get 1-5 showers as needed. LPA was not provided proof that R1 was not being showered by staff. Based on interviews, file review, and observation; 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 "Resident rooms are unsanitary" it was alleged that R3's room was malodorous and R1's bathroom was dirty. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews stated that R3 is a resident who refuses to shower for extended periods of time and it is not the room the smells. Rooms are cleaned daily and R3 is also reminded daily to take a shower but they refuse. R3 confirmed to LPA that they do not like to shower and did not want to shower. R3 did not need assistance with showering and was fairly independent. LPA observed R3 refusing to shower or wanting assistance with showers during the initial visit. LPA did not observe the hallways to be malodorous during the initial and subsequent visit as the smell was coming from a resident and not the facility. LPA observed R1 to have a private bedroom with a private bathroom in the facility. LPA observed the bathroom to be clean and appear unused. LPA was not provided with proof of the resident rooms being unsanitary. Based on interviews, file review, and observation; 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 are using resident's bathroom" it was alleged that staff were using R1's private bathroom. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff deny using R1s room for their own personal break time. Staff denied using any residents bathrooms for their own personal use. Staff have a designated restroom on each floor which they can use when needed and should not be using a residents bathroom. R1 was unable to confirm whether any staff were using their restroom. Based on interviews, file review, and observation; 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

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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20220207115219
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: 08/15/2023
NARRATIVE
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In regards to the allegation "Staff did not notify resident's authorized representative of incidents" it was alleged that R1 had scratches on their arm that were not reported to R1's authorized representative. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews state that R1 did have a scratch on her arm at one point and it was initially observed by R1s family member. The exact date is not known. interviews state that R1's family member observed the scratch prior to any staff being aware of it. Since the family member was the first to observe it, the staff could not have known and notified them prior. LPA did not find documentation on hand of the alleged scratch on R1's arm. Interviews with R1's hospice agency stated that any incidents were always noted and family member and facility was notified. LPA was not provided the notes from the hospice agency during the investigation. Based on interviews, file review, and observation; 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 "Residents room is in disrepair" it was alleged that R1's blinds, sliding door, and emergency call button were broken or missing. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that rooms are checked often for damages and residents can also report damaged to staff so things can be fixed in timely manner. Interviews do not show that there were any issues with the blinds or sliding door in R1's room not working. There were also no known issues with the emergency button in R1's room. According to interviews, sometimes the moving blinds will have a part that falls off but they just clip back on and does not mean they are broken. During the initial visit LPA observed the blinds and sliding door in R1's room to be working and in good condition. As for the call button, LPA observed it to be present in the room during the initial visit. There was one in the room and another in the bathroom. During the initial visit, LPA pressed the emergency button in R1's room and observed staff arriving to assist within 2 minutes. LPA did not observe the buttons to be in disrepair or to be missing. There were no signs of items or things in disrepair in R1's room during the initial visit. Based on interviews, file review, and observation; 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 are not ensuring resident has call bracelet on as required by admissions agreement" it was alleged that the facility staff did not ensure that R1 had their emergency pendant on at all times. (8) of (8) Staff interviewed denied the allegation....
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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20220207115219
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: 08/15/2023
NARRATIVE
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(6) of (6) Residents interviewed could not corroborate the allegation. Interviews state that R1 was provided an emergency pendent and that R1 would not like to have it on. Staff interviews explained R1 would have issues with the pendant around their neck and so it was removed and placed on the dresser at times. R1 was not able to communicate with LPA to confirm. LPA reviewed R1's file and observed that the pendant was purchased as a one time cost and that it would be provided to R1. Review of the admissions agreement and service plan does not state that staff would manage the pendant or make sure R1 had it on at all times. Based on interviews, file review, and observation; 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 are not providing adequate food service to resident's" it was alleged that R1 was not getting sufficient food and that it was not good enough. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. LPA observed the food supply during the initial and subsequent visit. There was no spoiled or expired food present. LPA reviewed the food menus and nutritionist notes and did not observe issues with the quality of the food provided by the facility. Interviews with staff stated R1 was assisted daily into the dining room for all meals and was observed to finish their plate during meals. Based on interviews, file review, and observation; 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 are not providing adequate laundry service to resident" it was alleged that R1 would soil their clothes and the staff would not wash it. (8) of (8) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews with staff show that R1's clothes were washed in the same consistency as every other resident. There is a schedule for washing clothes and is done that way so that no residents clothes get mixed up with one another. Staff denied refusing to wash and clean R1's clothes and stated that R1's clothing was always washed. LPA was not provided proof that R1's clothing was not washed. Based on interviews, file review, and observation; 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 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: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5