198603162-5-23-2024-28-AS-RORN-D7PTK6-20240731144726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:59:48 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
05/15/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240515115023

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	BARBA AGUIRRE, ITZAYANA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 75	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Lizbeth Acuna		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not accept resident back into care following hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted unannounced initial visit to facility to investigate the above allegation. LPA met with Lizbeth Acuna. Welness Director Kathleen McDonald, arrived shortly after and LPA discussed the purpose of the visit.

During today's visit LPA obtained copies of staff and residents roster. Interviews conducted with Welness Director Kathleen McDonald and Staff #1 - Staff #3 (S#1 - S#3). LPA also obtained copies of the following documents in reference to Resident #1:Admission Agreement, Face Sheet, Physician report, Preplacemen Appraisal Information,Hospice documents, SIRs dated 3/27/24 and 5/12/24, Individual Service Plan.

Continue 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240515115023

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: 05/23/2024

NARRATIVE

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Regarding allegation: "Staff did not accept resident back into care following hospitalization". It was alleged that R1 was ready to be discharged from the hospital, however when Hospital Social worker / Case Manager contacted the facility to coordinate the discharge, Facility staff refused to accept R1 back due to R1 "high levels."

On 05/12/24, Resident #1 was admitted to Whittier Hospital Medical Center. Interviewed Case Manager from the Hospital stated that Resident #1 was ready to return to the facility on 05/15/24, but Facility refused to accept Resident #1 back to facility. Interviewed S#1 and S#3 stated that they aware of R1's hospitalization, but don't have any discharge information or not accepting back to the facility. Interviewed S#2 stated that he/she spoke with discharged nurse from the hospital and was notify that R1 was ready to discharge on 05/12/24. S#2 ask the nurse for R#1 discharge documents and medications and discharge nurse said everything is ready and they will arrange the transportation for R1. The information that R1 cannot be back to the facility, S#2 get from R1's POA when POA came to the facility to find out the reason that R1 cannot be accepted back to the facility. Interviewed Wellness Director denied the allegation. Facility did not refuse to accept R1 back from the hospital. Stated that he/she spoke to the hospital staff and told them that they will accept R1 back, after R1's behavior will be stabilized. Wellness Director indicated that R1 was hospitalized because of R1's behavior. Due to the fact the staff refused to accept Resident #1 back to the facility after being discharge on 05/15/2024 is considered an unlawful eviction. A review of the R1's file revealed no indication that R1 required a higher level of care. LPA did not observe any documentation of giving residents a 30 day notice of removal from the facility.

Based on LPA interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

See LIC 9099D.

An exit interview was conducted, and a copy of this report was provided along with the Appeals Rights.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240515115023

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: 05/23/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/30/2024 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	87224 Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph...	1 2 3 4 5 6 7	Administrator will review Title 22 Regulations, Section 87224 on Eviction Procedures, and submit a written statement to CCL ensuring that he/she understands and will comply with Title 22 Regulations pursuant to this section by the POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on LPA interviews and record review, Facility / administrator refusal to accept R1 back to the facility upon discharge from hospital and not providing R1 with the 30 day eviction notice which poses a potential health, safety or personal rights risk to the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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