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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 12/13/2024
Date Signed: 12/13/2024 04:50:11 PM

Unsubstantiated


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
11/18/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241118145129
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:
12/13/2024
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Kathleen McDonald - Wellness DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility not assisting residents in obtaining medical care
Facility is malodorous and dirty
Facility does not dispense resident medications as prescribed
Facility did not notify resident's responsible party regarding missed medical appointments
Facility did not meet resident's dietary needs
Facility did not meet residents showering needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to address the allegations listed above. LPA with Kathleen McDonald, Wellness Director for the facility, and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 11/21/2024, LPA obtained the staff rosters, resident rosters, facility house rules, toured the kitchen and one (1) resident bedroom, interviewed Residents #1 - 7 (R1 - R7), Staff #1 - 2 (S1 - S2), and also obtained documentation including R1's Physician's Report, Resident Appraisal, FACE Sheet, log of R1's transportation for their medical appointments, and also a progress note for R1. During Today's visit, LPA toured seven (7) additional bedrooms, checked the Medication Administration Records (MARs) and medications for eight (8) residents, interviewed Staff #3 - 5 (S3 - S5), and interviewed Resident #8 (R8).
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
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 7
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
11/18/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241118145129

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:
12/13/2024
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Kathleen McDonald - Wellness DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Residents are drinking alcohol on premises
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to address the allegation listed above. LPA with Kathleen McDonald, Wellness Director for the facility, and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 11/21/2024, LPA obtained the staff rosters, resident rosters, facility house rules, toured the kitchen and one (1) resident bedroom, interviewed Residents #1 - 7 (R1 - R7), Staff #1 - 2 (S1 - S2), and also obtained documentation including R1's Physician's Report, Resident Appraisal, FACE Sheet, log of R1's transportation for his medical appointments, and also a progress note for R1. During Today's visit, LPA toured seven (7) additional bedrooms, checked the Medication Administration Records (MARs) and medications for eight (8) residents, interviewed Staff #3 - 5 (S3 - S5), and interviewed Resident #8 (R8).
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 28-AS-20241118145129
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: 12/13/2024
NARRATIVE
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The investigation revealed the following: In regards to the allegation that "Residents are drinking alcohol on premises," it is alleged that residents drink beet outside in the front porch area of the facility. During interviews with the residents, three (3) out of eight (8) corroborated the allegation. One of the residents stated that they have witnessed other residents drinking alcohol on the front porch area of the facility. Another resident also stated that some residents drink on the front porch of the facility and they sometimes drink heavily. LPA observed during the initial visit that one of the residents interviewed was drinking alcohol in front of the facility and was also displaying symptoms of heavy drinking. During interviews with the staff, three (3) out of five (5) corroborated the allegation. One of the staff witnessed the resident drinking in front of the facility along with the LPA and stated that the resident typically only drinks in their room. Another staff member stated that they have also observed residents drinking in front of the facility before as well. While reviewing the house rules for the facility, it states that "Alcoholic beverages are allowed in our community, in moderation. Alcoholic beverages must be enjoyed in resident rooms and are not permitted in our common areas."

Based on LPA interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 is being cited on the attached LIC9099D.

Exit interview was held and a copy of the report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 28-AS-20241118145129
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: 12/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
87468.2(a)(4)
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(a) In addition to the rights listed in Section 87468.1 (...) residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Administrator is to ensure that the house rules are enforced by the facility staff at all times to ensure proper supervision. Administrator is to submit a written plan to LPA explaining how the facility will ensure that they will ensure the house rules related to drinking alcohol will be enforced by the POC due date.
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This regulation is not met as evidenced by: Based on observation, record review, and interview, LPA determined that at least one resident had been drinking heavily in a common area in the facility, which poses a potential health and safety risk to clients 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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 28-AS-20241118145129
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: 12/13/2024
NARRATIVE
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The investigation revealed the following: In regards to the allegation that "Facility not assisting residents in obtaining medical care," it was alleged that R1 was not obtaining assistance in coordinating and scheduling transportation to their medical appointments from the facility staff members, and that staff had no notes of R1's required appointments. During interviews with the residents, seven (7) out of eight (8) interviewed did not corroborate the allegation. One of the residents stated this allegation is simply not true and that the facility assists all residents with coordinating transportation to their medical appointments. Another resident interviewed stated that they have never had any problems getting assistance from staff in obtaining transportation to their medical appointments. During interviews with the staff, five (5) out of five (5) did not corroborate the allegation. One staff member stated that R1 has been obtaining transportation to their medical appointments, and that they missed one appointment due to a scheduling problem with the facility bus, however since then there had been no issues. Another staff member stated that they do assist residents with coordinating transportation to their medical appointments, and when the facility bus is not available then they will order an Uber for the resident and have a caregiver be transported with them. During record review of the facility transportation log LPA observed that R1 obtained transportation to multiple appointments in the months of November, October, September, and July of 2024.

In regards to the allegation that "Facility is malodorous and dirty," it is alleged that there are resident rooms that smell of mildew and urine and that they are dirty as well. During interviews with the residents, eight (8) out of either (8) interviewed did not corroborate the allegation. One resident interviewed stated that they believe the housekeepers of the facility do a good job of helping clean their room on a consistent basis. Another resident similarly stated that they believed their rooms are cleaned adequately. During interviews with the staff, five (5) out of five (5) interviewed did not corroborate the allegation. One housekeeper stated that they clean up to six (6) different resident rooms once to twice per day, and that other housekeepers cover the remaining rooms of the facility. Another staff member stated that they were not aware of any resident bedrooms that were malodorous or not being cleaned. During the tour of the eight (8) resident rooms and common areas, LPA did not observe any room that was dirty, in disrepair, or malodorous.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 28-AS-20241118145129
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: 12/13/2024
NARRATIVE
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In regards to the allegation that "Facility does not dispense resident medications as prescribed," it is alleged that R1 had not been receiving their medications from the facility staff in over a year. During interviews with the residents, six (6) out of eight (8) stated that they were not getting their medications as prescribed. One resident stated that they have had no issues in obtaining the medications that they need. Another resident stated that they did have one issue obtaining their medications when they arrived at the facility, however it has since been resolved and there have been no additional issues. During interviews with the staff, five (5) out of five (5) did not corroborate the allegation. One staff member interviewed stated that R1 has always received their medications, and there has never been an issue in distributing medications to them. Another staff member similarly stated that there have not been any issues in providing R1 their medications. During record review of the MARs and medications for the eight (8) residents, LPA observed that R1 had all of their required medications based on their physician's orders.

In regards to the allegation that "Facility did not notify resident's responsible party regarding missed medical appointments," it is alleged that R1 had missed several doctor's appointments and that their responsible party was never informed of these missed appointments, the most recent one being for a 9/3/2024 appointment. During interviews with the residents, eight (8) out of eight (8) interviewed did not corroborate the allegation. One of the residents stated that as far as they understand the facility has been notifying their families and responsible parties of all significant and important events that occur in the facility. Another resident interviewed stated that they believe the facility staff keep their families updated with all significant information related to the facility and themselves. During interviews with the staff, five (5) out of five (5) did not corroborate the allegation. One staff member indicated that they did not have a family contact on file for R1 before 9/3/2024, and that they had added the contact on this date. According to a progress note recorded on 9/3/2024, R1 provided confirmation that they were adding the family member to their profile so that the facility can provide information to them.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 28-AS-20241118145129
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: 12/13/2024
NARRATIVE
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In regards to the allegation that "Facility did not meet resident's dietary needs," it is alleged that the facility is not following a health-appropriate diet for R1 based on their medical history. During interviews with the residents, eight (8) out of eight (8) did not corroborate the allegation. One of the residents interviewed stated that they do not have a specialized diet that the facility needs to meet and therefore did not corroborate the allegation. Another resident interviewed stated that the facility is meeting all of their dietary needs. During interviews with the staff, five (5) out of five (5) did not corroborate the allegation. One of the staff interviewed stated that they provide the kitchen staff the physician's orders for clients that have specialized diets to ensure that they are all receiving health-appropriate diets. A kitchen staff interviewed stated that they follow the list of orders for all residents when preparing food for the day to ensure that they meet the dietary needs of residents. LPA reviewed the list of specialized diets located in the kitchen of the facility and observed R1's physician's order for his specialized diet located on the list.

In regards to the allegation that "Facility did not meet residents showering needs," it is alleged that staff have not assisted R1 with bathing in over a week. During interviews with the residents, eight (8) out of eight (8) did not corroborate the allegation. One of the residents interviewed stated that all of their activities of daily living (ADL) needs are being met by the facility. Another resident similarly stated that all of their needs are being met by the facility. During interviews with the staff, (5) out of five (5) did not corroborate the allegation. One of the staff interviewed that R1 does not in fact require assistance with showering. Another staff interviewed stated that R1 showers themselves, and that staff only have staff on standby in case R1 slips and falls while showering. During record review of R1's physician's report and appraisal, it states that R1 does not require assistance with bathing or showering.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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 held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7