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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/20/2024
Date Signed: 05/20/2024 04:51:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/14/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240514095705
FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:BARBA AGUIRRE, ITZAYANAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 76DATE:
05/20/2024
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Kathleen McDonald, Wellness Director TIME COMPLETED:
05:08 PM
ALLEGATION(S):
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Staff are not ensuring that resident in care is provided their medication(s) as necessary.
Staff did not assist resident to perform their glucose testing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced initial visit to facility to investigate the above allegation(s). LPA met with Kathleen McDonald, Wellness Director and LPA discussed the purpose of the visit.

The investigation consisted of the following: LPA interviewed Five (5) staff (S#1-S#5), Eight (8)Residents R#1-R#8. LPA reviewed and obtained Staff and resident rosters, R1 MAR, R1 list of medications, R1 Physician's Report for Residential Care Facilities for the Elderly (RCFE), R1 Resident Admission Agreement, R1 bed rail order and facility food menu for the week. LPA also took tour of facility and random rooms.

The investigation revealed:

Allegation: Staff are not ensuring that resident in care is provided their medication(s) as necessary.
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
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 5
Control Number 28-AS-20240514095705
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER GLEN ASSISTED LIVING
FACILITY NUMBER: 198603162
VISIT DATE: 05/20/2024
NARRATIVE
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It is alleged that R1 was admitted to facility on 4/19/2024 and required insulin and that it was not ordered by facility until 05/14/2024. LPA interviewed eight (8) residents and seven (7) of (8) residents could not collaborate the allegation. LPA interviewed five (5) staff and three (3) of five (5) staff stated they did not know because medications are not within their scope of work. S1 stated the medication was ordered on 4/19/2024 and they were waiting on doctors orders. No documentation was provide to support statement. One (1) staff stated that R1 medication was not ordered until 05/14/2024 and could not explain why. LPA reviewed R1 doctor's orders and the order form shows that the medication was ordered on 05/14/24 with a start date of 05/15/2024. The resident went with out medication for 25 days.

Allegation: Staff did not assist resident to perform their glucose testing. It is alleged that facility did not provide resident with glucose meter until 25 days from admission.

The investigation revealed: Review of documentation and medical records indicate that resident was admitted to facility on 04/19/2024 and resident arrived without a glucose meter. Resident's glucose meter arrived the same day (05/15/2024) as the medication according to S1. Facility failed to assist resident in testing R1 glucose for 25 days.

Based on record review, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency is cited according to California Code of Regulations, Title 22. See LIC 9099D.

Exit interview was conducted with Kathleen McDonald, Wellness Director A copy of the report and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20240514095705
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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: 05/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2024
Section Cited
CCR
87628(a)(b)(2)
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(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c).

This requirement was not met as evidence by:
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Licensee will send a written plan to LPA on how facility will avoid residents from going without medication and send it to LPA by POC date which is 05/21/2024
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Medication records were reviewed for R1. R1 was admitted to facility on 04/19/2024 and facility did not received the resident's insulin and glucose meter until 05/14/2024. R1 went 25 days without glucose testing and insulin which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/14/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240514095705

FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:BARBA AGUIRRE, ITZAYANAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 76DATE:
05/20/2024
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Kathleen McDonald, Wellness Director TIME COMPLETED:
05:08 PM
ALLEGATION(S):
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Staff do not ensure that resident(s) are provided a sufficient amount of food while in care.
Staff are not meeting resident’s bathing needs
Staff made inappropriate comment to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced initial visit to facility to investigate the above allegation(s). LPA met with Kathleen McDonald, Wellness Director and LPA discussed the purpose of the visit.

The investigation consisted of the following: LPA interviewed Five (5) staff (S#1-S#5), Eight (8)Residents R#1-R#8. LPA reviewed and obtained Staff and resident rosters, R1 MAR, R1 list of medications, R1 Physician's Report for Residential Care Facilities for the Elderly (RCFE), R1 Resident Admission Agreement, Facility food menu for the week. LPA also took tour of facility and random rooms.

Allegation: Staff do not ensure that resident(s) are provided a sufficient amount of food while in care. It is alleged that facility does not provide sufficient food for residents.

(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
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 5
Control Number 28-AS-20240514095705
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: WHITTIER GLEN ASSISTED LIVING
FACILITY NUMBER: 198603162
VISIT DATE: 05/20/2024
NARRATIVE
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The investigation revealed: LPA interviewed five (5) staff and five (5) of five (5) staff denied the allegation. LPA interviewed eight (8) residents and seven (7) of eight (8)residents could not collaborate the allegations. One resident stated that he is not aware he could ask for more food. LPA interviewed five (5) staff and five (5) of (5) staff denied the allegation. All staff stated that residents can eat as much as they like and just have to ask for more food if they desire more. LPA was present during the lunch hour and observed the food served to be plentiful and nutritious. Plates were removed after residents had finished their meals and many if not most plates had uneaten food. There is not enough evidence to substantiate this allegation.

Allegation: Staff are not meeting resident’s bathing needs. It is alleged that residents are not assisted with bathing needs. LPA interviewed eight (8) residents and seven (7) of eight (8) residents could not collaborate the allegations. R1 stated R1 had sponge bath 3 days ago. LPA interviewed five (5) staff and five (5) of (5) staff denied the allegation. Staff stated that residents are assisted with bathing 2 times per week.
There is not enough evidence to substantiate this allegation.

Allegation: Staff made inappropriate comment to resident. It is alleged that unknown staff told resident "you're nasty" LPA interviewed eight (8) residents and eight (8) of eight (8) residents could not collaborate the allegations. All residents stated staff are respectful and considerate towards them. LPA interviewed five (5) staff and five (5) of (5) staff denied the allegation. Staff stated they are always respectful towards residents. There is not enough evidence to substantiate this allegation.

Based on interviews, and observations conducted, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are 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 copy of report provided to Wellness Director, Kathleen McDonald
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5