198603162-3-7-2024-28-AS-LHIS-D3ZJSK-20240404071825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 03/07/2024
Date Signed: 03/07/2024 03:45:19 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
02/27/2024 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240227155221

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	FORSGREN, MICHAEL		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 70	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Lizbeth Acuna		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent residents from engaging in inappropriate behaviors.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint visit at the facility and met with Business Office Manager Lizbeth Acuna to discuss the purpose for todays visit.

Investigation consisted of: LPA requested a copy of the resident roster, staff roster, interviewed staff, interviewed residents, requested a copy of the incident report for altercation in dinning room, house rules, eviction notices, and notice of court hearing.

The investigation revealed:Staff did not prevent residents form engaging inappropiate behaviors. R2 and R3 were in the dinning room and began an exchange of words. R2 hit R3 in the upper head area and R7 and R8 witnessed the incident. Staff called the police and the police suggested that R3 get a restraining order. R3 has a temporary restraining order and has to go to court on 03/26/24. LPA conducted interviews with other residents who says R2 starts problems with them all the time, and two of the residents were

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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 2

Control Number 28-AS-20240227155221

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: 03/07/2024

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

interviewed and said R2 doesn't start any mess with them at all. R1 and R2 refused to be interviewed. The Business Office Manager said they are aware and cant share information about one resident with another. They have a legal team that will be handling the situation. The staff are trained in de escalating a situation, but the staff was not present during this argument. When staff found out about it, they intervened and that's when the police were called. LPA Wesley spoke to 3 other residents who have had altercations with R2 and and seems to think that he has a drinking problem due to him being a Veteran, which is causing his aggression.

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.

A copy of this report was given to the Business Office Manager.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2