198603162-6-3-2025-28-AS-FFIS-DJDT9L-20250708143207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 06/03/2025
Date Signed: 06/03/2025 03:02:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/29/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250529130258

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: 73	DATE:	06/03/2025
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Wellness Director- Kathleen McDonald		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff not meeting resident’s grooming needs.
Staff not emptying resident’s commode.
Staff not administering resident’s medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 06/03/2025, regarding the above allegations. LPA Ramirez identified herself to Receptionist- Michelle Bascom and was granted entry into the facility. Business Office Manager- Lizbeth Acuna and Wellness Director- Kathleen McDonald greeted LPA and assisted with facility tour.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 6 interviews (S1 – S6), Resident#2 - 6 interviews (R2-R6), Attempted Interview of Resident#1 (R1), Copies of Residents# 1-6 (R1 – R6) Physician’s Report and Physician’s orders, Copies of Documentation Survey Report on bathing/showering, dressing, and housekeeping for Resident#1 (R1) for May 2025, Unusual Incident/Injury Report (LIC624) for Resident#1 (R1), Medication Administration Record (MAR) for May 2025 for Resident#1 (R1), and physical plant tour.

SEE 9099 for continued report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025

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-20250529130258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 06/03/2025

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff not meeting resident’s grooming needs.” It is alleged facility staff do not assist R1 with grooming needs. Review of R1’s physician’s report revealed R1 can bathe and dress/groom themselves with staff assistance. Review of R1’s Documentation Survey Report for May 2025, did not corroborate this allegation. Staff interviews conducted did not corroborate this allegation. Resident interviews conducted did not corroborate this allegation. R1 was not present at the facility during LPA Ramirez’s visit and therefore was not interviewed. 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.

“Staff not emptying resident’s commode.” It is alleged facility staff are not emptying R1’s commode. Review of R1’s physician’s report revealed R1 can tend to their own toiletry needs with staff assistance. Review of R1’s Documentation Survey Report for May 2025, did not corroborate this allegation. Staff interviews conducted did not corroborate this allegation. Resident interviews conducted did not corroborate this allegation. R1 was not present at the facility during LPA Ramirez’s visit and therefore was not interviewed. 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.

“Staff not administering resident’s medication as prescribed.” It is alleged facility staff are not administering R1’s fungal medication. Review of R1’s Physician’s Report revealed R1 is unable to administer their own medication and store their own medication. Review of R1’s Physician’s Order revealed, on 05/12/2025, R1’s primary physician ordered Nystatin Powder 100000 UNIT/GM to be applied to affected areas two times a day. Review of R1’s MAR for May 2025 revealed, facility staff began administering Nystatin Powder on 05/13/2025, according to R1’s physician’s order. Staff interviews conducted did not corroborate this allegation. R1 was not present at the facility during LPA Ramirez’s visit and therefore was not interviewed. 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.

No deficiencies were cited for this investigation. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025

LIC9099 (FAS) - (06/04)

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