198603222-5-6-2024-28-AS-RORN-D5GLC4-20240521083741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603222
Report Date: 05/06/2024
Date Signed: 05/06/2024 03:30:27 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
01/17/2024 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240117100508

FACILITY NAME:	WHITTIER PLACE SENIOR LIVING		FACILITY NUMBER:	198603222
ADMINISTRATOR:	CASTILLO,JOSHUA		FACILITY TYPE:	740
ADDRESS:	12315 BURGESS AVENUE		TELEPHONE:	(562) 777-1477
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90604
CAPACITY:	125	CENSUS: 61	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Joshua Castillo		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Lack of staff resulting in residents not being administered their medication(s) as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Joshua Castillo, who assisted with today's visit. **The purpose of the visit is to remove confidential information listed on the report dated 3/22/24, however, the finding will remain the same**

Regarding the allegation that : Lack of staff resulting in residents not being administered their medication(s) as prescribed. The investigation consisted of interviews with Administrator, staff #1 - staff #4, and resident #1- resident #5. LPA also reviewed resident #6's medication administration record. The investigation revealed the following : Administrator stated that a medication technician from a staffing agency was due to come in to work on 1/14/24. However, the medication technician dropped the shift, and did not come to the facility. Administrator stated that resident #6 did receive their medication on 1/14/24, however it was given late.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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-20240117100508

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 PLACE SENIOR LIVING	FACILITY NUMBER: 198603222
	VISIT DATE: 05/06/2024

NARRATIVE

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Staff interviewed corroborated the allegation. Four out of five staff interviewed stated that resident #6's medication was administered late, and not as prescribed. Residents interviewed were unable to corroborate the allegation. Five out of five residents interviewed stated either that they handle their own medication, or that their medication is administered as prescribed.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Mr. Castillo. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20240117100508

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 PLACE SENIOR LIVING	FACILITY NUMBER: 198603222
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/08/2024 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.	1 2 3 4 5 6 7	Administrator will ensure that residents receive medications as prescribed. Administrator will send LPA a written plan detailing what the facility plan is to ensure that there is sufficient staff to administer medications as prescribed.
	8 9 10 11 12 13 14	This requirement is not being met as evidenced : LPA Rea learned that Resident #6 prescribed medication OLANZAPINE F/C 2.5MG TABLET which is to be administered every day at 4:00pm was not given as prescribed. This poses a health and safety risk to residents in care.	8 9 10 11 12 13 14
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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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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