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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603220
Report Date: 02/23/2021
Date Signed: 02/24/2021 01:08:42 PM



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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/17/2020 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20201217154333
FACILITY NAME:CITY VIEW LA, LLCFACILITY NUMBER:
198603220
ADMINISTRATOR:ROSIE JULINEKFACILITY TYPE:
740
ADDRESS:515 N LA BREA AVETELEPHONE:
(323) 938-3128
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:166CENSUS: 63DATE:
02/23/2021
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:ADMINISTRATOR ROSIE JULINEKTIME COMPLETED:
02:26 PM
ALLEGATION(S):
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Allegation: Facility is in disrepair
INVESTIGATION FINDINGS:
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On 02/23/2021 around 2:00 pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019(COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically via face time with Administrator Rosie Julinek.

The Investigation consisted of the following: On 12/24/2020 LPA Calderon interviewed Administrator Rosie Julinek (S1) and conducted a tour of the physical plant. LPA obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS, admission agreement for R1, Elevator maintenance for 3 months. On 01/11/2021 LPA Calderon interviewed maintenance supervisor (S2). On 01/14/2021 interviewed R2-R6. On 2/5/2021 LPA Calderon interviewed Wellness Director (S3). On 2/8/21 LPA interviewed (S4).

The investigation revealed the following:

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021
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
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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/17/2020 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20201217154333

FACILITY NAME:CITY VIEW LA, LLCFACILITY NUMBER:
198603220
ADMINISTRATOR:ROSIE JULINEKFACILITY TYPE:
740
ADDRESS:515 N LA BREA AVETELEPHONE:
(323) 938-3128
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:166CENSUS: 63DATE:
02/23/2021
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:ADMINISTRATOR ROSIE JULINEKTIME COMPLETED:
02:26 PM
ALLEGATION(S):
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9
Allegation: Facility staff mismanaged resident’s medication
INVESTIGATION FINDINGS:
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On 02/09/2021 around 2:00 pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019(COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically via face time with Administrator Rosie Julinek.

The Investigation consisted of the following: On 12/24/2020 LPA Calderon interviewed Administrator Rosie Julinek (S1) and conducted a tour of the physical plant. LPA obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS, admission agreement for R1, Elevator maintenance for 3 months. On 01/11/2021 LPA Calderon interviewed maintenance supervisor (S2). On 01/14/2021 interviewed R2-R6. On 2/5/2021 LPA Calderon interviewed Wellness Director (S3). On 2/8/21 LPA interviewed (S4).

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021
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 5
Control Number 11-AS-20201217154333
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CITY VIEW LA, LLC
FACILITY NUMBER: 198603220
VISIT DATE: 02/23/2021
NARRATIVE
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Allegation: Facility staff mismanaged resident’s medication

It is alleged on facility staff took R1 medication away and is not administering it properly. On 12/24/2020 LPA Calderon interviewed R1 who stated staff took away some medication from her moving box. On 12/24/2020 LPA Calderon interviewed Administrator Julinek S1 who stated that staff took away loose medication from R1 moving box which they could not identify. On 01/14/2021 LPA Calderon interviewed R2-R6 who all stated no issues with staff managing their medications. On 01/08/2021 reviewed R1 medical records which state R1 could take her own medication without any help from staff. On 02/03/2021 had meeting via face time with administrator (S1) and Wellness Director (S3) and reviewed MAR, no discrepancies was observed. On 02/05/2021 LPA Calderon interviewed S1 & S3 who stated R1 was paying for medication services and that they took away some loose vitamins from a box, but did receive doctors’ instructions for Clonazepam, Coq10, Duloxetine, Ezetimibe and Lamotrigine which R1 did not take herself.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A telephonic exit interview was conducted with Administrator Rosie Julinek and a hard copy was provided via
email for records
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20201217154333
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CITY VIEW LA, LLC
FACILITY NUMBER: 198603220
VISIT DATE: 02/23/2021
NARRATIVE
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Allegation: Facility is in disrepair

It is alleged facility roof top patio rail was loose, elevator was not working. On 12/24/2020 LPA Calderon toured facility with Administrator Julinek (S1). LPA Calderon toured the roof patio and noted damage to rail and loose concrete. Administrator stated repair of the patio was pending. LPA reviewed color photos of the roof patio on 01/08/2021 which showed repair to rail and concrete was completed. Elevator maintenance records were reviewed and stated no mechanical issues were found. On 12/21/2020 LPA Calderon interviewed R1, resident stated she was on the roof top patio and pulled a loose piece of concrete from the rail. On 01/14/2021 LPA Calderon interviewed S2 who stated damage to roof patio rail was repaired. On 01/14/2021 LPA Calderon interviewed R2-R6 who all state no issues with facility or roof patio or elevators. On 2/8/2021 LPA Calderon interviewed concierge (S4) who stated R1 brought piece of concrete from the roof patio and stated that the roof rail was unsafe.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Administrator Rosie Julinek, and a hard copy was provided via email for records
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20201217154333
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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CITY VIEW LA, LLC
FACILITY NUMBER: 198603220
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/12/2021
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (e) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:

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Correction done at time of visit. Received color photos of roof patio
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Based on observations and interviews roof top patio rail did have loose concrete which poses a potential health, safety 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.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5