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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603222
Report Date: 07/26/2024
Date Signed: 07/26/2024 02:40:13 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
01/20/2023 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230120113757
FACILITY NAME:WHITTIER PLACE SENIOR LIVINGFACILITY NUMBER:
198603222
ADMINISTRATOR:WASHINGTON, MELANIEFACILITY TYPE:
740
ADDRESS:12315 BURGESS AVENUETELEPHONE:
(562) 777-1477
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:125CENSUS: 69DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Joshua Castillo TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident developed pressure wounds while in care.
Facility is neglecting resident's care.
Facility failed to provide timely medical attention to resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea made another visit to issue the final results of the investigation. LPA met with Mr. Castillo, who assisted with today's visit.

Regarding the allegation that : Resident developed pressure wounds while in care. The investigation was conducted by the department, and consisted of of interviews, review of facility documentation, and review of resident #1 medical records. Hospital records show that resident #1 was admitted to the hospital on 12/5/22 due to a fall, and did not have any pressure injuries. Resident #1 was re-admitted to the hospital on 1/16/23 and was diagnosed with an unstageable pressure injury on his right hip, a deep tissue injury on his right hip, and an unstageable pressure injury on his right foot. Per facility documentation provided, on 1/10/23, the pressure injuries on resident #1 were noted. Resident #1's family member stated that they were permitted and relied upon to perform wound care from 1/11/23-1/15/23 at the facility. The investigation found sufficient evidence to show that resident #1 developed pressure wounds while in care of the facility.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 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 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
01/20/2023 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230120113757

FACILITY NAME:WHITTIER PLACE SENIOR LIVINGFACILITY NUMBER:
198603222
ADMINISTRATOR:WASHINGTON, MELANIEFACILITY TYPE:
740
ADDRESS:12315 BURGESS AVENUETELEPHONE:
(562) 777-1477
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:125CENSUS: 69DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Joshua Castillo TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Facility does not have sufficient staff which has resulted in resident leaving the facility unattended.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea made another visit to issue the final results of the investigation. LPA met with Joshua Castillo, who assisted with today's visit.

Regarding the allegation that :Facility does not have sufficient staff which has resulted in resident leaving the facility unattended. The investigation was conducted by the department, and consisted of of interviews, review of facility documentation, and review of resident #1 medical records. Interviews conducted were unable to corroborate that resident #1 left the facility unattended. Attempts were made to interview resident #1's family member, however LPA was unable to interview resident #1's family member to obtain additional information. Resident #1 was no longer living at the facility when LPA conducted initial visit, and was not interiewed.

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 conducted, and a copy of the report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 28-AS-20230120113757
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: 07/26/2024
NARRATIVE
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Regarding the allegation that : Facility is neglecting resident's care. The investigation was conducted by the department, and consisted of of interviews, review of facility documentation, and review of resident #1 medical records. Per hospital records, upon admittance resident #1 had "oral cavity dryness, crusting, and debris" due to "poor oral intake and poor oral care at the facility". Resident #1 was diagnosed with a staphylococcus (staph) infection in his mouth. Additionally, hospital records show that staff neglect of resident #1, resulted in a weight loss of sixteen pounds within approximately six weeks. On 12/5/22, resident #1 was admitted to the hospital weighing 150 lbs. On 1/16/23, resident #1 was admitted to the hospital weighing 134 lbs. Per reports provided by the facility, dated 1/11/23, 1/12/23, 1/14/23, and 1/15/23, it was noted that resident #1 was unable to eat, chew, or swallow his food. Resident #1 was diagnosed with severe malnutrition upon admittance to hospital on 1/16/23. The investigation found sufficient evidence to show that the facility was neglecting resident #1's care.

Regarding the allegation that : Facility failed to provide timely medical attention to resident in care. The investigation was conducted by the department, and consisted of of interviews, review of facility documentation, and review of resident #1 medical records. Upon being admitted to the hospital on 1/16/23, resident #1 was diagnosed with severe sepsis with acute organ dysfunction, pneumonia, hypernatremia, due to dehydration, severe protein calorie malnutrition, in addition to the unstageable pressure injury on his right hip, a deep tissue injury on his right hip, and an unstageable pressure injury on his right foot. The investigation found sufficient evidence to show that the facility failed to provide timely medical attention to resident #1.

Based on interviews which were conducted with staff and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on the attached LIC 9099D.

Immediate Civil Penalty will be issued in the amount of $500.00

The licensee was informed that a civil penalty might be assessed based on health and safety code 1569.49 (e) or (f).

Exit interview conducted, and copy of report and appeal rights were provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 28-AS-20230120113757
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: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2024
Section Cited
CCR
876615(a)(1)
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(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries.

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Licensee will ensure that the facility abides by Title 22 regulations, and does not retain resident(s) with prohibited health conditions. LIcensee will ensure that an in service training with staff is provided, on Section 876615, and will provide LPA with proof of training by POC date.
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This requirement was not being met as evidenced by : Resident #1 was admitted to the hospital on 1/16/23 with an unstageable pressure injury on his right hip, a deep tissue injury on his right hip, and an unstageable pressure injury on his right foot.

This poses an immediate health, safety, or personal rights risk to persons in care.
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Type A
08/02/2024
Section Cited
CCR
87465(a)(1)
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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: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Licensee will ensure that the facility abides by Title 22 regulations. Licensee will ensure that an in service training is provided with staff on Section 87465, and will provide LPA with proof of training by POC due date.
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This requirement was not being met as evidenced by : Resident #1 was diagnosed with a staphylococcus (staph) infection in his mouth, upon hospital admittance on 1/16/23.
This poses an immediate health, safety, or personal rights risk 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: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20230120113757
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: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2024
Section Cited
CCR
87466
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The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.
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Licensee will ensure that the facility abides by Title 22 regulations. Licensee will ensure that staff are provided with an in service training on Section 87466, and will provide LPA with proof of training by POC due date.
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This requirement was not being met as evidenced by : resident #1 was admitted to hospital on 1/16/23, and diagnosed with severe malnutrion. It is documented that resident #1 lost sixteen lbs between 12/5/22, and 1/16/23.

This poses an immediate health, safety, or personal rights risk to persons in care.
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Type A
08/02/2024
Section Cited
CCR
87468.2(a)(4)
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(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:
4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs
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Licensee will ensure that the facility abides by Title 22 regulations. Licensee will ensure that staff are provided with an in service training on Section 87468.2, and will provide LPA with proof of training by POC due date.
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This requirement was not being met as evidenced by : resident #1 was admitted to hospital on 1/16/23, with severe sepsis with acute organ dysfunction, pneumonia, hypernatremia, severe protein calorie malnutrition. and several pressure injuries.
This poses a an immediate health, safety, or personal rights risk 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: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5