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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603222
Report Date: 08/02/2022
Date Signed: 08/02/2022 02:01:54 PM

Unsubstantiated


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
07/20/2020 and conducted by Evaluator Elizabeth Ceniceros
COMPLAINT CONTROL NUMBER: 28-AS-20200720145227
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: DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator, Gloria Paul & Interim ED, Brenda RitterTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not provide 60-day notice prior to increasing the resident's rate

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Interim ED (A2: Brenda Ritter) and the new Administrator (A1: Gloria Paul). LPA spoke to A2 upon arrival to the community to conduct a risk assessment. A2 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

An initial 10-Day virtual visit was conducted (via telephone) by LPA Angelica Rea on 07/23/20 with (former) Administrator Melanie Washington due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. LPA Rea interviewed (former) Administrator Washington regarding the complaint allegation and requested and obtained copies of specific documents that included: Resident #1's admission agreement, assessment, and 60-day Notice of care rate increase.

(Cont on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Araceli RamirezTELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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-20200720145227
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: 08/02/2022
NARRATIVE
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Regarding Allegation #1: this investigation revealed that the facility provided a letter (dated 11/05/19) to residents and family regarding adjust care rates, effective January 5, 2020; and, care rates will remain the same unless a change of condition occurs and care needs change or upon a resident's annual assessment update. A review of Resident #1's Admission Agreement (page 3 of 19) documented the increased rate following Resident #1's annual re-assessment (effective, 05/06/2020 at 11:44 a.m.) by (former) Staff #1 (S1: Ruth Tistoj, Program Director). Resident #1's Power of Attorney received an e-copy of the resident's re-assessment (dated regarding Resident #1's change of condition - including the letter (dated 01/05/20) that was provided to residents and family regarding adjust care rates.

Based on the evidence gathered and interviews conducted and records reviewed, 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 of is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report provided to Administrator, Gloria Paul.

SUPERVISOR'S NAME: Araceli RamirezTELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2