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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 04:43:27 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
12/09/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241209093245
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 McDonaldTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not distribute resident's medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial 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: LPA obtained the staff rosters, resident rosters, facility house rules, interviewed Residents #1 - 8 (R1 - R8), Witness #1 (W1), Staff #1 - 5 (S1 - S5), and also obtained documentation including R1's Physician's Report, Resident Appraisal, FACE Sheet, land also reviewed the Medication Administration Records (MARs) and medications for eight (8) residents.

The investigation revealed the following: In regards to the allegation that "Staff do not distribute resident's medications as prescribed," it is alleged that on the dates of 12/3/2024 and 12/4/2024, R1 was not provided their required medication as prescribed by the staff, which resulted in R1's hospitalization.
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 2
Control Number 28-AS-20241209093245
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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During interviews with the residents, six (6) out of eight (8) did not corroborate the allegation. During an interview with R1, they stated that they were not being provided their medications by staff in the days leading up to their medical emergency, and they have since had their significant other assisting them with medication management. Other residents interviewed stated that they have not had issues with receiving their medications from staff as prescribed by their physicians. During interviews with the staff, five (5) out of five (5) did not corroborate the allegation. One of the staff interviewed stated that they were not aware of any instances in which medications were not passed to R1, and that the significant other of R1 now handles their medications so the facility only has the MAR for R1. During review of the MAR, LPA observed that it was documented that on 12/3/2024 and 12/4/2024, it was logged that S2 had distributed R1 their medications. During an interview with S2, they stated that on these dates that they had given R1 their required medications and observed R1 taking the medications. LPA was not able to inspect the medication for R1 because their medications are with their significant other.

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: 2 of 2