198603162-2-22-2024-28-AS-RORN-D3APQE-20240312113100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:21:44 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
02/07/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220207115219

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: 73	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Wellness Director Kathleen McDonald		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff left resident in soiled diapers for extended period of time

INVESTIGATION FINDINGS:

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** This report supercedes report dated 8/15/2023. Further inofrmation was aquired resulting in changes to the findings and details on 9099's**

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPA met with Wellness Director Kathleen McDonald and the purpose of the visit was discussed.

Visits conducted on 2/16/22 and 8/15/23 consisted of the following: LPA Villalobos interviewed Staff #1-#8 (S1-S8). LPA toured the facility and observed the food supply. LPA reviewed resident #1 (R1) and resident #2's (R2) file. LPA collected copies of R1 and R2's file. LPA also received a copy of the staff and resident roster. LPA interviewed Residents #1-6 (R1-R6), and Hospice agency for R1. LPA collected hospice agency documents for regarding R1. The Investigation revealed the following:

Continued on LIC 9099-C

Substantiated

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: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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 8

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 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: 73	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Wellness Director Kathleen McDonald		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Resident fell while in care
Resident's sustained injuries while in care
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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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: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 8

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: 02/22/2024

NARRATIVE

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In regards to the allegation "Resident fell while in care" it was alleged that R2 fell in the facility resulting in head wound 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 and needed to shout for help. Staff denied that they would refuse to assist any resident in care. Interviews did show R2 having an unwitnessed fall on 2/2/22 in their room and staff assessed R2 and assisted them back to their bed. No head injuries were noted during file review. 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 leaving wounds on their arm. (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 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. File review shows shower notes for R1 being completed 2 times a week. 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 Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 8

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: 02/22/2024

NARRATIVE

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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 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

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. Interview with R1's hospice agency also was not aware of scratches on R1 until they were notified by R1s family member. 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 Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 8

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: 02/22/2024

NARRATIVE

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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. (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

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: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 8

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: 02/22/2024

NARRATIVE

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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 the report with appeal rights were provided and discussed.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 7 of 8

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: 02/22/2024

NARRATIVE

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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 they would attempt to change R1 each shift. File review shows that R1's service plan stated R1 was at risk of incontinence and required regular assistance with toileting needs to avoid skin breakdown. Interviews with staff show that there were moments where R1 was having incontinence issues but due to workload, staff was not always able to immediately assist R1 with diaper changes. File review further shows that R1's hospice agency observed R1 to have rash issues around their genital area on 2/5/22. It was noted that a correction was needed and that diaper changes were to be done frequently. This shows that the facility failed to change R1's soiled diapers in a timely manner. Based on LPA interviews, record review, and observations 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 were provided and discussed.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 8

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/07/2024 Section Cited CCR 87625(b)(3)	1 2 3 4 5 6 7	87625.Managed Incontinence(b)In addition to Section 87611... the licensee shall be responsible for the following:(3)Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.	1 2 3 4 5 6 7	Facility to provide in service training to staff in regarding information on providing residents assistance with toileting needs. Letter of completion signed by staff attending to be provided to Licensing by POC due date.
	8 9 10 11 12 13 14	This was not met as evidenced by: R1 was left unchanged for prolonged times resulting in rashes. This 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 Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

Page: 8 of 8