198603222-4-23-2024-28-AS-LHIS-D54K74-20240509073829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603222
Report Date: 04/23/2024
Date Signed: 04/23/2024 01:22:03 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
04/17/2024 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240417102216

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: 60	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Joshua Castillo		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident sustained multiple unexplained bruises and scratches while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint investigation regarding the above allegation. LPA met with Administrator, Joshua Castillo who assisted with the visit.

Regarding the allegation that : Resident #1 sustained multiple unexplained bruises and scratches while in care. The investigation consisted of interviews with Administrator, Staff #1 - Staff #2, resident #1 - resident #4, and review of resident #1's file. LPA also obtained copies of specific documents from resident #1's file.

The investigation revealed the following : Administrator and staff interviewed stated that on 4/14/24, staff #3 observed that resident #1 had a bruise on her left arm during a safety check. Staff interviewed stated that the family was notified and a special incident report was submitted to community care licensing as required. Staff interviewed were unable to corroborate the allegation. Three out of three staff interviewed stated that they have not observed anything that may have caused resident #1 to sustain any bruises or scratches.

Unsubstantiated

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: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20240417102216

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: 04/23/2024

NARRATIVE

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Residents interviewed were unable to corroborated the allegation. Four out of four residents interviewed stated that they have not had any incidents which would cause them any bruising or scratches.

Based on staff and resident interviews, although resident #1 sustained bruising to her left arm, there is nothing to support that this occurred due to staff negligence.

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.

Exit interview conducted, and a copy of the report was provided to Mr. Castillo.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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