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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004192
Report Date: 06/24/2024
Date Signed: 06/24/2024 09:21:35 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240520140910
FACILITY NAME:WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
306004192
ADMINISTRATOR:STEVE SHENFACILITY TYPE:
740
ADDRESS:200 WEST WHITTIER BLVD.TELEPHONE:
(562) 691-1200
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:196CENSUS: 127DATE:
06/24/2024
UNANNOUNCEDTIME BEGAN:
07:35 AM
MET WITH:Kate BernalTIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with staff Kate Bernal, discussed the purpose of the inspection, and explained the allegation. Administrator (AD) Allen Nishikawa was not present during the inspection.

The investigation into the allegation that staff handled resident in a rough manner revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, an Unusual Incident Report received May 17, 2024, Resident #1’s (R1) Physician’s Report dated November 2, 2023, R1’s Monthly Case Manager Visit Summary dated April 18, 2024, and R1’s Assisted Living Waiver Assessment dated November 22, 2023.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
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 2
Control Number 22-AS-20240520140910
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WHITTEN HEIGHTS ASSISTED LIVING AND MEMORY CARE
FACILITY NUMBER: 306004192
VISIT DATE: 06/24/2024
NARRATIVE
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Regarding the allegation that staff handled resident in a rough manner: it was alleged that staff are handling residents in a rough manner resulting in injuries. LPA interviewed AD who was unable to provide information about the allegation. LPA reviewed the facility’s recently reported incidents and noted an Unusual Incident Report received May 17, 2024, which states that on May 16, 2024, R1, a memory care resident with Dementia, was agitated and angry with Staff #1 (S1) for telling R1 to return to their room because it was time to go to sleep, R1 knocked over a trash can, taunted S1, followed S1 into another resident’s room, knocked off S1’s hat and hit S1 on the back, then S1 turned quickly to face R1, R1 was startled and fell backwards, hitting their arm against a nearby chair and receiving a cut and bruise on their arm. LPA conducted a health and safety check on and interviewed R1 who reported that R1 and S1 “hate each other,” during this incident R1 knocked S1’s hat off and then S1 pushed R1 from behind which caused R1 to hit a railing and cut their arm, no one else was present during the incident, R1 has never seen S1 engage in similar behavior with other residents, and this was the only incident between R1 and S1. LPA reviewed R1’s Physician’s Report dated November 2, 2023 which states R1 has Dementia and is frequently confused, R1’s Monthly Case Manager Visit Summary dated April 18, 2024 which states R1 had been more angry lately and fixated on one resident and got into an altercation with that resident, and R1’s Assisted Living Waiver Assessment dated November 22, 2023 which states R1 has multiple cognitive impairments, is sometimes agitated, disruptive, and/or aggressive, and states R1 lacks awareness of their limitations and often tries to exceed what is safely achievable and given their history of falls there is a heightened risk of injury due to lack of safety awareness. LPA interviewed S1 who stated that during this incident, R1 was fixated on S1, followed S1, and knocked S1’s hat off as reported, but denied that S1 pushed R1 and stated that R1 fell on their own. S1 also stated that this is not the first time R1 has attacked S1. LPA interviewed four other residents, none of whom corroborated the allegation. LPA interviewed three other staff, none of whom corroborated the allegation. The information obtained regarding whether R1’s fall was caused by S1 or whether R1 fell on their own is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC9099 (FAS) - (06/04)
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