Inspection Report Summary
Most inspections found no deficiencies, with many complaint investigations unsubstantiated, indicating generally consistent compliance with regulations. However, several substantiated deficiencies have occurred over time, primarily involving medication management, staffing levels, resident care documentation, and personal rights issues such as safeguarding belongings and resident dignity. The most recent report from August 5, 2025, substantiated deficiencies related to medication dispensing errors and insufficient staffing, posing immediate health and safety risks. Previous reports also noted issues with incident reporting, food service quality, and failure to maintain qualified administrators, but no fines or license suspensions were listed in the available reports. While some improvements appeared between older and more recent inspections, the pattern of isolated but meaningful deficiencies suggests ongoing areas needing attention.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 85
Capacity: 93
Deficiencies: 2
Aug 5, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-07-01 regarding medication dispensing, medication management, and timely response to call buttons among other allegations.
Findings
The investigation substantiated that staff did not ensure medications were dispensed as prescribed and medications were not properly managed, including missed doses and continued administration of discontinued medication. It was also substantiated that staffing levels were insufficient to meet resident needs timely. Other allegations related to laundry, soiled clothing, facility odors, floor cleanliness, and privacy of phone conversations were found to be unsubstantiated.
Complaint Details
The complaint investigation was substantiated. Allegations included missed medication dispensing, improper medication management, and delayed response to call buttons. Evidence showed medication discrepancies for two residents and insufficient staffing. Other allegations about laundry, soiled clothing, malodors, floor cleanliness, and privacy were unsubstantiated.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Medication for Resident #3 was not administered as prescribed by the physician, posing immediate health and safety risks. | Type A |
| Facility personnel were not sufficient in numbers and competent to provide necessary services to meet resident needs. | Type B |
Report Facts
Residents' medications reviewed: 7
Residents with medication discrepancies: 2
Staff interviewed: 12
Residents interviewed: 8
Plan of Correction due dates: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Itzayana Barba | Administrator | Met with Licensing Program Analyst during investigation and involved in plan of corrections. |
| Cynthia D Chan | Licensing Program Analyst | Conducted the complaint investigation. |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation and signed the report. |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 0
Jun 3, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted on 06/03/2025 in response to allegations that staff were not meeting resident grooming needs, not emptying resident's commode, and not administering resident's medication as prescribed.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and resident interviews, documentation reviews, and physician reports did not corroborate the complaints. No deficiencies were cited.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not meeting resident grooming needs, not emptying the resident's commode, and not administering medication as prescribed. Evidence reviewed included physician reports, medication administration records, staff and resident interviews, and documentation surveys. The resident involved was not present during the visit. All allegations were found unsubstantiated due to lack of sufficient evidence.
Report Facts
Facility capacity: 93
Census: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kimberly Ramirez | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Named in report signature and management |
| Kathleen McDonald | Wellness Director | Met with investigator and assisted with facility tour |
| Lizbeth Acuna | Business Office Manager | Assisted with facility tour during investigation |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 0
Apr 8, 2025
Visit Reason
An unannounced complaint investigation was conducted to investigate the allegation that staff were not ensuring residents were provided a safe environment.
Findings
The investigation found that roommates had a physical altercation, but staff took appropriate actions by separating them. Interviews with residents and staff did not corroborate the allegation, and no hazards were observed during the facility tour. The allegations were determined to be unsubstantiated due to lack of sufficient evidence.
Complaint Details
The complaint alleged that staff were not ensuring a safe environment due to a physical altercation between two residents. The allegation was unsubstantiated after investigation, interviews, and review of records.
Report Facts
Residents interviewed: 10
Residents not corroborating allegation: 8
Staff interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
| Itzayana Barba Aguirre | Administrator | Facility Administrator present during investigation |
| Kathleen McDonald | Wellness Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 0
Mar 27, 2025
Visit Reason
The visit was a subsequent case management inspection in response to an initial case management visit following the death of Resident #1 who choked during a meal on 12/31/2024.
Findings
The investigation found that staff responded quickly and appropriately to the choking incident, and the resident's meal was prepared as ordered. There was insufficient evidence to substantiate the allegations related to the incident, and the allegations were deemed unsubstantiated.
Complaint Details
The complaint investigation was triggered by the death of Resident #1 due to choking on food. The investigation included interviews with staff and residents, review of resident files, and the death certificate. The allegations were found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 93
Resident census: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the case management visit and investigation |
| Christine Ferris | Investigations Branch Investigator | Conducted investigation including interviews and obtaining death certificate |
| Kathleen McDonald | Wellness Director | Met with during the inspection visit |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 0
Mar 27, 2025
Visit Reason
An unannounced complaint investigation was conducted to investigate the allegation that staff did not meet residents' needs, specifically regarding difficulty residents had entering restrooms due to narrow doors and lack of staff assistance.
Findings
The investigation included interviews with residents and staff, room tours, and record reviews. Most residents and staff did not corroborate the allegation, and observations showed wheelchairs could pass through restroom doors. There was insufficient evidence to substantiate the complaint, resulting in an unsubstantiated finding.
Complaint Details
The complaint alleged that residents had significant difficulty entering restrooms due to narrow doors and lack of staff assistance. Interviews with five of seven residents and all staff did not support the allegation. Observations confirmed wheelchairs could pass through restroom doors. The complaint was determined to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Residents interviewed: 7
Staff interviewed: 4
Resident bedrooms toured: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
| Kathleen McDonald | Wellness Director | Met with investigator during complaint visit |
| Itzayana Barba | Executive Director | Met with investigator during complaint visit |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 1
Jan 24, 2025
Visit Reason
The inspection was an unannounced case management visit conducted in response to a Serious Incident Report dated 2025-01-02 describing the passing of a client (Client #1).
Findings
The Licensing Program Analyst found that the facility lacked a pre-admission or recent appraisal for Client #1, which posed a potential health and safety risk. Staff performed CPR and used an AED on the client during the incident before the client was declared deceased.
Complaint Details
The visit was complaint-related, triggered by a Serious Incident Report regarding the passing of Client #1. The report documents the incident and the facility's response, including staff actions and record reviews.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| No available pre-admission appraisal or recent appraisal for Client #1, posing a potential health and safety risk to residents in care. | Type B |
Report Facts
Capacity: 93
Census: 74
Plan of Correction Due Date: Feb 14, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kathleen McDonald | Wellness Director | Met with the Licensing Program Analyst during the visit |
| David Sicairos | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 1
Dec 13, 2024
Visit Reason
The inspection was conducted as a complaint investigation following allegations received on 2024-11-18 regarding multiple concerns including failure to assist residents in obtaining medical care, facility cleanliness, medication dispensing, notification of missed medical appointments, dietary needs, showering needs, and residents drinking alcohol on premises.
Findings
The investigation substantiated the allegation that residents were drinking alcohol on the premises in common areas, violating house rules. All other allegations including failure to assist with medical care, facility cleanliness, medication dispensing, notification of missed appointments, dietary needs, and showering needs were found to be unsubstantiated based on interviews, observations, and record reviews.
Complaint Details
The complaint investigation was triggered by multiple allegations including failure to assist residents in obtaining medical care, facility being malodorous and dirty, failure to dispense medications as prescribed, failure to notify responsible parties of missed medical appointments, failure to meet dietary and showering needs, and residents drinking alcohol on premises. The allegation regarding residents drinking alcohol on premises was substantiated, while all other allegations were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| At least one resident was observed drinking heavily in a common area, posing a potential health and safety risk to clients in care. | Type B |
Report Facts
Facility capacity: 93
Census: 76
Plan of Correction due date: Jan 10, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Kathleen McDonald | Wellness Director | Facility staff member met with during investigation |
| Barba Aguirre, Itzayana | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 0
Dec 13, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not distribute resident's medications as prescribed.
Findings
The investigation included interviews with residents, staff, and review of medication records. The allegation that staff failed to distribute medications to Resident #1 on 12/3/2024 and 12/4/2024, resulting in hospitalization, was not substantiated due to insufficient evidence.
Complaint Details
The complaint alleged that staff did not distribute Resident #1's medications as prescribed on 12/3/2024 and 12/4/2024, leading to hospitalization. Interviews with residents and staff, and review of medication administration records did not corroborate the allegation. The complaint was determined to be unsubstantiated.
Report Facts
Capacity: 93
Census: 76
Dates of alleged medication omission: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kathleen McDonald | Wellness Director | Facility staff member interviewed during investigation |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 0
Dec 5, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2024-12-02 regarding staff mismanagement of resident's medication, inadequate transportation services, and failure to prevent resident harm.
Findings
The investigation found no evidence to substantiate the allegations. Medication records and interviews with staff and residents showed no missing medications. Transportation logs and interviews confirmed alternate transportation was provided when needed. Staff and residents denied any failure to prevent altercations between residents. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint involved three allegations: 1) staff mismanaged resident's medication, 2) staff did not provide adequate transportation services, and 3) staff did not prevent a resident from harming another resident. After review of medication, transportation logs, and interviews with staff and residents, the allegations were found to be unsubstantiated due to lack of sufficient evidence.
Report Facts
Capacity: 93
Census: 76
Staff interviewed: 5
Residents interviewed: 10
Medication reviews: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tena Herrera | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Lizbeth Acuna | Business Office Manager | Facility representative met during investigation |
| Barba Aguirre, Itzayana | Administrator | Facility administrator named in report header |
Inspection Report
Annual Inspection
Census: 79
Capacity: 93
Deficiencies: 0
Oct 15, 2024
Visit Reason
The inspection was an unannounced required 1-year visit to evaluate compliance with care and regulatory standards at the Whittier Glen Assisted Living Facility.
Findings
The inspection covered 12 CARE tool domains including infection control, physical plant safety, staffing, resident rights, and more. No deficiencies were observed during the visit, and the facility was found to be in good repair with adequate staffing and compliance with regulations.
Report Facts
Residents receiving hospice services: 6
Staff files reviewed: 7
Resident files reviewed: 7
Fire clearance capacity: 93
Hospice waiver capacity: 15
Emergency drill date: Oct 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Itzayana Barba Aguirre | Executive Director | Met with Licensing Program Analyst during inspection |
| Erik Zaragoza | Licensing Program Analyst | Conducted the inspection |
| David Sicairos | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 0
Aug 5, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to multiple allegations regarding kitchen cleanliness, infection control practices, food serving practices, meal portion sizes, and kitchen equipment maintenance at Whittier Glen Assisted Living Facility.
Findings
The investigation found no evidence to substantiate the allegations. The kitchen and dining areas were clean, no cockroach activity was observed, infection control practices were followed, meal portions were adequate, and kitchen equipment was properly maintained. Staff and residents denied the allegations and observations confirmed compliance.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included kitchen not being free of cockroaches, improper infection control practices, serving food from the floor, inadequate meal portions, and moldy kitchen equipment. None of these were confirmed by the Licensing Program Analyst's observations, staff interviews, resident interviews, or documentation review.
Report Facts
Facility capacity: 93
Census: 79
Pest control service dates: Service dates reviewed: 06/10/24, 07/08/24, 07/22/24
Menu weeks reviewed: Food menus for weeks 07/21/24 - 07/27/24, 07/28/24 - 08/03/24, 08/04/24 - 08/10/24, 08/11/24 - 08/17/24
Juice machine service month: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Wei Siew Ho | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Citlali Galeana | Wellness Coordinator | Interviewed during the investigation and participated in exit interview |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
May 23, 2024
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that staff did not accept a resident back into care following hospitalization.
Findings
The investigation found that the facility staff refused to accept Resident #1 back after hospital discharge on 05/15/2024 without providing the required 30-day eviction notice, constituting an unlawful eviction. The allegation was substantiated based on interviews and record reviews.
Complaint Details
The complaint alleged that staff did not accept Resident #1 back into care following hospitalization. The allegation was substantiated after investigation, with evidence showing refusal to accept the resident back on 05/15/2024 and no documentation of a 30-day eviction notice.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility/administrator refusal to accept Resident #1 back upon discharge from hospital and failure to provide 30-day eviction notice, posing potential health, safety, or personal rights risk to residents. | Type B |
Report Facts
Capacity: 93
Census: 75
Plan of Correction Due Date: May 30, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Kathleen McDonald | Wellness Director | Interviewed during investigation; denied the allegation |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 1
May 20, 2024
Visit Reason
An unannounced complaint investigation was conducted to investigate allegations that staff did not ensure residents received their medications as necessary and did not assist a resident with glucose testing.
Findings
The investigation substantiated that a resident went 25 days without insulin and glucose testing due to delayed medication and equipment delivery. Other allegations regarding insufficient food, unmet bathing needs, and inappropriate staff comments were unsubstantiated based on interviews and observations.
Complaint Details
The complaint investigation was substantiated regarding failure to provide timely insulin and glucose testing assistance to a resident admitted on 04/19/2024. The resident did not receive medication or glucose meter until 05/14/2024, resulting in a 25-day gap. Other allegations about food sufficiency, bathing assistance, and staff conduct were unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure a resident with diabetes received insulin and glucose testing equipment timely, resulting in 25 days without medication or glucose testing. | Type A |
Report Facts
Days without medication and glucose testing: 25
Capacity: 93
Census: 76
Deficiency Plan of Correction Due Date: May 21, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Lisa Hicks | Licensing Program Manager | Oversaw the complaint investigation. |
| Kathleen McDonald | Wellness Director | Facility representative met during the investigation and exit interview. |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
Apr 30, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to multiple allegations received on 08/14/2023 regarding staff not logging incidents, neglect leading to resident falls, unmet resident needs, residents left in soiled diapers, unmet showering needs, and insecure rent payment methods.
Findings
The investigation found that most allegations were unsubstantiated based on interviews, observations, and file reviews, except for the allegation that staff were not properly logging incidents involving residents. The facility failed to report certain incidents to Licensing as required, which was substantiated and cited as a deficiency.
Complaint Details
The complaint investigation was substantiated for failure to log and report incidents properly. Other allegations including resident falls due to staff neglect, unmet resident needs, residents left in soiled diapers, unmet showering needs, and insecure rent payment methods were found unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to properly report incidents to licensing as required by CCR 87211(a)(1)(D), including an incident report dated 6/1/23 of a resident hospitalization and a 12/6/22 resident threat incident. | Type B |
Report Facts
Capacity: 93
Census: 75
Deficiency count: 1
Plan of Correction Due Date: May 14, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Forsgren | Administrator | Facility administrator named in the report |
| Lizbeth Acuna | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 1
Apr 19, 2024
Visit Reason
An unannounced visit was conducted to cite deficiencies related to a complaint dated 03/18/2022 concerning multiple documented falls of Resident #1 during March 2022.
Findings
The facility failed to update Resident #1's service plan to reflect changes in condition and implement fall interventions, resulting in additional falls and a head laceration requiring hospitalization. Deficiencies were cited per California Code of Regulations, Title 22.
Complaint Details
Investigation was conducted due to a complaint dated 03/18/2022 regarding Resident #1's falls. The complaint was substantiated by findings of failure to update care plans and implement interventions.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to update Resident #1's appraisal/plan of care to implement fall interventions after documented falls, leading to a head laceration. | Type B |
Report Facts
Capacity: 93
Census: 74
Deficiencies cited: 1
Plan of Correction Due Date: Apr 24, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Maldonado | Licensing Program Analyst | Conducted the unannounced visit and cited deficiencies |
| Lizbeth Acuna | Business Office Manager | Met with Licensing Program Analyst during inspection |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection |
| Michael Forsgren | Administrator/Director | Facility Administrator named in report header |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 0
Apr 18, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that staff did not post Community Care Licensing (CCL) signs in an accessible area for residents.
Findings
The investigation found that all required postings, including the administrator's certificate and various resident rights forms, were posted in accessible areas. Staff and residents interviewed denied the allegation. There was insufficient evidence to substantiate the complaint, so it was deemed unsubstantiated.
Complaint Details
The allegation was that staff did not post CCL signs in an accessible area for residents. Five staff members denied the allegation, and two residents could not corroborate it. Observations confirmed required postings were present and accessible. The allegation was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 93
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 0
Apr 18, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2023-04-06 regarding care plan provision during pre-admissions, forged resident signatures, and overcharging residents.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and residents denied the allegations, documentation and interviews supported that care plans are created upon admission, charges are properly communicated, and no proof of forged signatures was found. Therefore, all allegations were unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to provide care plans during pre-admission, forged resident signatures, and overcharging residents. Interviews with staff and residents, file reviews, and observations did not support the allegations.
Report Facts
Capacity: 93
Census: 74
Staff interviewed: 4
Residents interviewed: 6
Residents files reviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Lizbeth Acuna | Business Office Manager | Met with investigators during the visit |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Mar 20, 2024
Visit Reason
An unannounced complaint investigation visit was conducted to ascertain the validity of allegations including a resident possibly possessing a firearm and a resident verbally attacking another resident.
Findings
The investigation included interviews with staff and residents and a room tour. No evidence was found to substantiate the allegations, and the complaint was determined to be unsubstantiated.
Complaint Details
The complaint involved two allegations: 1) a resident possibly possessing a firearm, and 2) a resident verbally attacking another resident. Interviews with seven residents and eight staff members, as well as a room inspection, found no evidence supporting the allegations. The situation between the residents involved verbal arguments but no physical harm, and staff intervened promptly. The allegations were deemed unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 93
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Wong | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
| Michael Forsgren | Administrator | Facility administrator mentioned in report |
| Kathleen McDonald | Wellness Director | Assisted with the visit and interview |
| Michelle Bascom | Receptionist | Allowed entry into the facility during the visit |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Mar 7, 2024
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2024-02-27 regarding staff not preventing residents from engaging in inappropriate behaviors.
Findings
The investigation revealed that staff did not prevent residents from engaging in inappropriate behaviors, specifically an altercation between residents R2 and R3. However, the allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff did not prevent residents from engaging in inappropriate behaviors. The investigation included interviews with staff and residents, review of incident reports, and other documentation. Despite evidence of an altercation and a temporary restraining order, the allegation was unsubstantiated.
Report Facts
Facility capacity: 93
Census: 70
Complaint receipt date: Feb 27, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicol Wesley | Licensing Program Analyst | Conducted the complaint investigation visit |
| Lizbeth Acuna | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Lisa Hicks | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 1
Feb 22, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2022-02-07 regarding resident care and facility conditions at Whittier Glen Assisted Living Facility.
Findings
The investigation found most allegations unsubstantiated due to lack of preponderance of evidence, except for one substantiated allegation that staff left a resident (R1) in soiled diapers for extended periods, resulting in rashes and failure to provide timely diaper changes.
Complaint Details
The complaint investigation was substantiated for the allegation that staff left resident R1 in soiled diapers for extended periods, causing rash issues. Other allegations including resident falls, injuries, hygiene needs, unsanitary rooms, staff misuse of resident bathrooms, failure to notify authorized representatives, room disrepair, call bracelet issues, inadequate food and laundry services were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure incontinent residents are kept clean and dry, resulting in resident R1 being left unchanged for prolonged times causing rashes. | Type B |
Report Facts
Capacity: 93
Census: 73
Deficiency Plan of Correction Due Date: Mar 7, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Kathleen McDonald | Wellness Director | Facility representative met during the investigation |
Inspection Report
Complaint Investigation
Census: 69
Capacity: 93
Deficiencies: 0
Jan 16, 2024
Visit Reason
An unannounced complaint investigation was conducted following allegations of verbal abuse, threats, and yelling by a staff member towards residents at Whittier Glen Assisted Living Facility.
Findings
The investigation found that while some residents alleged verbal abuse, threats, and yelling by a staff member, the majority of staff and residents denied these allegations. The Wellness Director had addressed the concerns with the staff member. No disciplinary actions were found in the staff member's file. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint involved allegations that a staff member was verbally abusive, threatening, and yelled at residents. The investigation included interviews with staff and residents, file reviews, and observations. The allegations were found to be unsubstantiated.
Report Facts
Capacity: 93
Census: 69
Number of residents interviewed: 8
Number of staff interviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jewel Baptiste | Licensing Program Analyst | Conducted the complaint investigation |
| Lisa Hicks | Licensing Program Manager | Oversaw the complaint investigation |
| Michael Forsgren | Administrator | Facility administrator named in report header |
| Lizbeth Acuna | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Kathleen McDonald | Wellness Director | Participated in interviews and exit interview |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 1
Jan 11, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2022-08-30 concerning staffing, supervision after a resident fall, staff qualifications, medication management, and lack of a full-time Activity Director.
Findings
The investigation found the allegation that the facility lacked a full-time Activity Director from March to July 2022 to be substantiated. All other allegations including staff leaving a resident unsupervised after a fall, inadequate staffing, unqualified staff, and medication mismanagement were unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation addressed multiple allegations: staff left resident unsupervised after fall, facility not adequately staffed, staff not qualified to perform duties, staff mismanaged residents medications, and facility does not have a full time Activity Director. Only the last allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility went about 4 months without a full time activity coordinator for the residents, which poses a potential health and safety risk to residents in care. | Type B |
Report Facts
Capacity: 93
Census: 73
Deficiency count: 1
Plan of Correction Due Date: Jan 12, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Lizbeth Acuna | Business/HR Manager | Met with Licensing Program Analyst during investigation |
| Kimia Ateaiian | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Jan 11, 2024
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation that staff denied a resident's representative the right to represent the resident in matters pertaining to residency at the facility.
Findings
The investigation found that six staff members denied the allegation and five residents could not corroborate it. The resident in question had their needs met during their stay and left the facility in July 2023. There was an ongoing dispute between the resident's relative and the facility, but no preponderance of evidence was found to substantiate the allegation, resulting in an unsubstantiated finding.
Complaint Details
The allegation was that staff denied the resident's representative the right to represent the resident. Interviews with staff and residents did not support the allegation. The resident left the facility in July 2023. The resident's relative became responsible party and Power of Attorney on 09/10/2022. Facility administrators maintained contact with the relative throughout the dispute. No proof was provided that the facility denied representation rights. The allegation was unsubstantiated.
Report Facts
Facility capacity: 93
Census: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
| Lizbeth Acuna | Business/HR Manager | Met with Licensing Program Analyst during investigation |
| Michael Forsgren | Administrator | Facility Administrator named in report |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Jan 10, 2024
Visit Reason
Unannounced complaint investigation conducted due to multiple allegations received on 03/17/2022 regarding resident care and facility practices at Whittier Glen Assisted Living.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Resident and staff interviews, record reviews, and observations indicated that medication was administered as prescribed, wheelchairs were locked only for safety reasons, residents were properly dressed and cleaned, and personal belongings were safeguarded. No deficiencies were cited.
Complaint Details
The complaint included allegations that the facility did not accept resident's prescribed medication, staff locked resident's wheelchair, resident was not properly dressed, resident was left in dirty clothing, and the facility did not safeguard resident's personal belongings. The investigation concluded the allegations were unsubstantiated due to lack of evidence.
Report Facts
Capacity: 93
Census: 70
Resident interviews: 8
Staff interviews: 5
Diaper check interval: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Kathleen McDonald | Wellness Director | Met with Licensing Program Analyst during investigation and exit interview |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 93
Deficiencies: 0
Jan 9, 2024
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to allegations that a resident sustained an injury from a fall while in care, staff did not address a resident's diabetic needs, and staff were using a resident's room for work breaks.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Resident and staff interviews, record reviews, and observations indicated that the resident's fall was not due to lack of care, diabetic needs were addressed appropriately, and staff did not use resident rooms for breaks. Therefore, the allegations were unsubstantiated and no deficiencies were cited.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included a resident injury from a fall, failure to address diabetic needs, and misuse of resident rooms for staff breaks. Interviews and record reviews did not corroborate these allegations, and no violations were found.
Report Facts
Facility capacity: 93
Census: 70
Number of residents interviewed: 8
Number of staff interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Itzayana Barba Aguirre | Executive Director/Administrator | Facility representative met during investigation |
| Kimia Ateaiian | Administrator | Named as facility administrator |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Dec 12, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2022-08-30 regarding disrespectful behavior by the administrator, failure to perform room checks, unaddressed bed bugs, and residents not being afforded comfortable accommodations.
Findings
The investigation included interviews with staff and residents, file reviews, and observations. All allegations were found to be unsubstantiated due to lack of preponderance of evidence, with staff and most residents denying the claims and documentation supporting appropriate care and responses.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included disrespectful communication by the administrator, failure to perform room checks, unaddressed bed bugs in a resident's room, and inadequate accommodations during a temporary relocation. Interviews and documentation did not support these claims.
Report Facts
Staff interviewed: 7
Residents interviewed: 5
Complaint received date: Aug 30, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kimia Ateaián | Administrator | Named in allegation of disrespectful communication |
| Lizbeth Acuna | Business/ HR Manager | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 0
Dec 7, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff do not treat residents with dignity and respect.
Findings
The investigation included interviews with staff and residents, review of training and records, and observations of staff-resident interactions. The allegation was found to be unsubstantiated due to insufficient evidence to prove the violation occurred.
Complaint Details
The allegation was that staff do not treat residents with dignity and respect. Interviews revealed most staff denied the allegation and confirmed training on dignity and respect. Residents mostly reported being treated with dignity and respect. Observations and record reviews supported these findings. The allegation was unsubstantiated.
Report Facts
Staff interviewed: 5
Residents interviewed: 6
Capacity: 93
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Calderon | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Administrator | Facility administrator named in report header |
| Kathleen McDonald | Wellness Director | Met with Licensing Program Analyst during investigation and received report copy |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 76
Capacity: 93
Deficiencies: 1
Oct 31, 2023
Visit Reason
The inspection was a subsequent unannounced required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools as part of the annual case management continuation.
Findings
The inspection covered all 12 CARE tool domains, with deficiencies cited related to incomplete hospice care plans for residents #1-#3, specifically lacking evidence of licensee/staff involvement, posing potential health, safety, or personal rights risks.
Deficiencies (1)
| Description |
|---|
| Hospice care plans for residents #1-#3 were incomplete by not showing licensee/staff involvement in residents' hospice care plans. |
Report Facts
Residents on Hospice: 6
Residents on Home Health: 25
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the inspection and signed the report |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 76
Capacity: 93
Deficiencies: 0
Oct 27, 2023
Visit Reason
An unannounced Required - 1 Year visit was conducted using the full Care Compliance and Regulatory Enforcement (CARE) Tools to evaluate the facility's compliance with regulatory standards.
Findings
Nine of twelve CARE tool domains were completed during the inspection, including infection control, operational requirements, physical plant safety, staffing, personnel records, resident records, resident rights, food service, and incident medical and dental. No deficiencies were cited during this visit.
Report Facts
Staff members: 42
Resident files reviewed: 8
Staff files reviewed: 7
Fire clearance capacity: 93
Liability insurance: 1000000
Liability insurance aggregate: 3000000
Water temperature range: 105-120
Resident medications reviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the unannounced Required - 1 Year visit |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 77
Capacity: 93
Deficiencies: 0
Oct 24, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that staff did not assist a resident with obtaining medical care, that staff dispensing medication were not appropriately trained, and that staff did not dispense medication as prescribed.
Findings
The investigation included interviews with staff and residents, review of resident and staff files, and observations. All allegations were found to be unsubstantiated due to lack of sufficient evidence to prove the violations occurred.
Complaint Details
The complaint investigation addressed three allegations: 1) staff did not assist resident with obtaining medical care, 2) licensee does not ensure staff dispensing medication are appropriately trained, and 3) staff did not dispense medication as prescribed. All allegations were unsubstantiated based on interviews, file reviews, and observations.
Report Facts
Facility capacity: 93
Census: 77
Staff interviewed: 7
Residents interviewed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
| Itzayana Barba | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Capacity: 93
Deficiencies: 0
Oct 24, 2023
Visit Reason
The visit was an unannounced complaint investigation to determine the validity of an allegation that a resident sustained a fracture while in care.
Findings
The investigation found insufficient evidence to substantiate the allegation that the resident sustained the fracture due to a fall at the facility. Interviews, records, and observations did not confirm the fracture was caused by the fall, and no deficiencies were cited during the visit.
Complaint Details
The complaint alleged that Resident #1 fell at the facility resulting in a fractured shoulder. The investigation included review of incident reports, x-ray records, staff and resident interviews, and medical documentation. The fracture was confirmed by x-ray but it was not established that it was caused by the fall at the facility. Staff and residents mostly denied the allegation. The complaint was determined to be unsubstantiated.
Report Facts
Facility capacity: 93
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Maldonado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Named in report header and signature |
| Itzayana Barba | Administrator | Met with Licensing Program Analyst during investigation |
| Kim Mims | Cluster Nurse | Participated in exit interview |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 2
Oct 2, 2023
Visit Reason
Unannounced complaint investigation visit conducted to investigate allegations including facility smelling of urine and staff serving residents cold meals.
Findings
The investigation substantiated that the facility common areas had a persistent odor of urine due to some residents refusing showers or diaper changes, and that meals were often served cold because plates absorbed heat and ovens were in disrepair.
Complaint Details
The complaint investigation was substantiated. Allegations included facility smelling of urine and staff serving cold meals. Interviews with staff and residents confirmed the odor was due to some residents refusing showers or diaper changes, and meals were served cold due to cold plates and broken ovens. Deficiencies were cited under California Code of Regulations, Title 22.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Managed Incontinence. Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. | Type B |
| General Food Service Requirements: The total daily diet shall be of the quality and quantity necessary to meet residents' needs and served in a safe and healthful manner. | Type B |
Report Facts
Staff interviewed: 6
Residents interviewed: 9
Residents census: 79
Facility capacity: 93
Deficiencies cited: 2
Plan of Correction due date: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lisa Hicks | Licensing Program Manager | Oversaw the complaint investigation |
| Itzayana Barba Aguirre | Executive Director | Facility representative met during investigation and named in findings related to odor and meal service |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 2
Oct 2, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by a complaint received on 2023-09-28 regarding allegations that staff serve residents cold meals.
Findings
The investigation substantiated that meals were often served cold due to cold plates absorbing heat and broken ovens previously used to warm plates. Additionally, there was an odor of urine in common areas, and deficiencies were cited related to food service and incontinence management.
Complaint Details
The complaint alleged that staff served residents cold meals. The allegation was substantiated based on interviews with staff and residents and observations. The report also noted an odor of urine in common areas, which was substantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Staff serves resident cold meal(s) not in a healthful manner. | Type B |
| Managed incontinence: incontinent residents not kept clean and dry; facility has odor of urine in common dining and kitchen areas. | Type B |
Report Facts
Capacity: 93
Census: 79
Staff interviewed: 6
Residents interviewed: 9
Residents confirming cold meals: 8
Residents confirming odor: 8
Staff confirming odor: 5
Plan of Correction Due Date: Oct 9, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Evaluator / Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Lisa Hicks | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Michael Forsgren | Administrator | Facility administrator named in the report |
| Itzayana Barba Aguirre | Person met with during the investigation |
Inspection Report
Complaint Investigation
Census: 79
Capacity: 93
Deficiencies: 1
Oct 2, 2023
Visit Reason
The inspection visit was conducted as a complaint investigation to assess reported issues regarding the operability of kitchen equipment posing health and safety risks.
Findings
The Licensing Program Analyst found that three ovens and the overhead vent in the kitchen were not operable, creating a health and safety risk to residents. A deficiency was cited under Title 22, Division 6 Chapter 8, Article 10 related to food services.
Complaint Details
The visit was complaint-related, and the deficiency was substantiated as the equipment was found not operable, posing a health and safety risk.
Deficiencies (1)
| Description |
|---|
| Three ovens and the overhead vent in the kitchen were not operable, posing a health and safety risk to residents. |
Report Facts
Deficiency Type: Type B deficiency cited related to food service equipment
Plan of Correction Due Date: Oct 30, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Discovered the kitchen equipment deficiencies during complaint investigation |
| Lisa Hicks | Supervisor | Named in relation to the exit interview and report supervision |
Inspection Report
Complaint Investigation
Census: 76
Capacity: 93
Deficiencies: 0
Sep 19, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that a resident sustained bruises while in care and that staff do not appropriately manage residents' behavior.
Findings
The investigation found insufficient evidence to substantiate the allegations. Staff and some residents denied the claims, and although incidents occurred, the facility was found to be addressing resident behavior appropriately within regulatory limits.
Complaint Details
The complaint involved two allegations: 1) Resident sustained bruises due to another resident's attack, and 2) Staff did not appropriately manage residents' behavior. Both allegations were unsubstantiated due to lack of preponderance of evidence despite some incidents and concerns noted.
Report Facts
Facility capacity: 93
Resident census: 76
Staff interviewed: 5
Residents interviewed: 5
Date of incident: Sep 3, 2022
Date of eviction notice: Sep 19, 2022
Date resident moved out: Oct 20, 2022
Date of last needs and services plan: Oct 3, 2022
Date mental health visited: Oct 2, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Forsgren | Administrator | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 76
Capacity: 93
Deficiencies: 0
Sep 19, 2023
Visit Reason
An unannounced case management visit was conducted to review and collect documentation of rent increases provided to residents of the facility in August 2022.
Findings
The Licensing Program Analyst reviewed resident census and rent charges, collected Resident Admission Agreements for 30 of 54 residents, and observed that 15 residents received notices of monthly care fee adjustments to reflect the current facility rate. The fee increases were not due to changes in care level or basic rent.
Report Facts
Residents listed on census: 54
Resident Admission Agreements collected: 30
Residents provided notice of fee adjustment: 15
Resident Admission Agreements remaining to be provided: 24
Current rate for Level 1 care: 525
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Administrator | Met with Licensing Program Analyst during visit |
| Jose Villalobos | Licensing Program Analyst | Conducted the unannounced case management visit |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Sep 14, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 03/25/2021 regarding staff treatment of residents, including dignity, respect, toileting, and eating needs.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Resident and staff interviews, facility tour, and record reviews indicated that residents were treated with dignity and respect, toileting and eating needs were met, and no inappropriate staff behavior was observed.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not treating residents with dignity and respect, yelling at residents, speaking inappropriately, failing to meet toileting needs, and failing to ensure eating needs were met. Interviews with residents and staff, record reviews, and facility observations did not corroborate these allegations.
Report Facts
Capacity: 93
Census: 75
Resident interviews: 8
Staff interviews: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Administrator | Met during the investigation and exit interview |
| Bonnie Tao | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Sep 5, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 04/14/2022 regarding medication administration and ordering practices at Whittier Glen Assisted Living Facility.
Findings
The investigation found no preponderance of evidence to substantiate the allegations that the facility administered medications no longer prescribed to a resident or failed to ensure current prescribed medications were ordered. Staff and resident interviews, medication record reviews, and observations supported the conclusion that the allegations were unsubstantiated.
Complaint Details
The complaint involved two allegations: 1) Facility administering medications no longer prescribed to a resident, and 2) Facility not ensuring resident's current prescribed medications were being ordered. Both allegations were found to be unsubstantiated based on interviews, medication record reviews, and observations.
Report Facts
Facility capacity: 93
Resident census: 75
Staff interviewed: 5
Residents interviewed: 5
Date complaint received: Apr 14, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted complaint investigation and interviews |
| Michael Forsgren | Administrator | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Sep 5, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to an allegation that facility staff does not provide a safe environment for residents while in care.
Findings
The investigation found that staff denied the allegation and residents expressed some concerns about safety related to a specific resident (R1) with behavioral issues. The facility took actions including eviction of R1 and notifying responsible parties. There was insufficient evidence to substantiate the allegation, resulting in an unsubstantiated finding.
Complaint Details
The allegation was that facility staff did not provide a safe environment for residents. Staff interviews denied the allegation, while some residents expressed feeling unsafe around R1. Incident reports and police involvement were reviewed. R1 was served an eviction notice and left the facility. Due to lack of preponderance of evidence, the allegation was unsubstantiated.
Report Facts
Facility capacity: 93
Census: 75
Complaint received date: Feb 16, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Forsgren | Administrator | Met with Licensing Program Analyst during the investigation |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Aug 31, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to ascertain information regarding an allegation that staff were retaliating against a resident for filing complaints.
Findings
The investigation included interviews with the administrator, four staff members, and eight residents. All residents and staff denied the allegation, and there was insufficient evidence to substantiate the complaint. The allegation was determined to be unsubstantiated.
Complaint Details
The allegation was that staff were retaliating against a resident for filing complaints. After interviews and investigation, the allegation was found to be unsubstantiated due to lack of evidence.
Report Facts
Capacity: 93
Census: 75
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Administrator | Met with Licensing Program Analyst and assisted with the complaint investigation visit |
| Christine Wong | Licensing Program Analyst | Conducted the complaint investigation visit |
| David Sicairos | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 0
Aug 15, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to multiple allegations received on 2022-02-07 regarding resident falls, injuries, hygiene, room conditions, staff conduct, and service adequacy at Whittier Glen Assisted Living Facility.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations including resident falls, injuries, hygiene neglect, unsanitary rooms, improper staff use of resident bathrooms, failure to notify authorized representatives, room disrepair, call bracelet issues, inadequate food and laundry services. All allegations were determined to be unsubstantiated based on interviews, file reviews, and observations.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included resident falls, injuries, hygiene neglect, unsanitary conditions, staff misuse of resident bathrooms, failure to notify family of incidents, room disrepair, failure to ensure call bracelets, and inadequate food and laundry services. Interviews with 8 staff and 6 residents, file reviews, and observations did not corroborate the allegations.
Report Facts
Facility capacity: 93
Census: 75
Staff interviewed: 8
Residents interviewed: 6
Allegations: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Michael Forsgren | Administrator | Facility administrator met during investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
Aug 11, 2023
Visit Reason
The visit was conducted to investigate complaints received on 06/29/2022 regarding resident bruising, inappropriate touching, and facility cleanliness at Whittier Glen Assisted Living Facility.
Findings
The investigation found the allegations of resident bruising, inappropriate touching, and unsanitary conditions to be unsubstantiated except for the allegation that staff did not properly supervise a resident, which was substantiated due to failure to verify a resident's capacity to consent to sexual encounters.
Complaint Details
The complaint investigation addressed allegations that a resident sustained a bruise while in care, a resident inappropriately touched other residents, and the facility was not maintained clean and sanitary. The bruising and cleanliness allegations were unsubstantiated. The inappropriate touching allegation was unsubstantiated due to lack of evidence. However, the investigation substantiated neglect/lack of supervision related to failure to verify Resident #2's capacity to consent to sexual encounters with Resident #3.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| The facility did not ensure Resident #2 had the capacity to establish consent for a sexual relationship, posing an immediate health, safety, or personal rights risk. | Type A |
Report Facts
Capacity: 93
Census: 75
Deficiency count: 1
Plan of Correction Due Date: Aug 25, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Joshua Oliver | Business Office Manager | Met with during inspection and exit interview |
| Michael Forsgren | Administrator | Met with during inspection and exit interview; named in findings related to lack of supervision |
| Jewel Baptiste | Licensing Program Analyst | Conducted the complaint investigation |
| Lisa Hicks | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 93
Deficiencies: 1
Jul 28, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-05-12 regarding the facility's failure to meet reporting requirements.
Findings
The investigation found that the facility failed to submit required incident reports to the licensing agency and to the resident's responsible party for incidents occurring on 7/14/22, which poses a potential personal right, health, or safety risk. Other alleged missing reports were either not applicable or had been provided. The allegation was substantiated based on interviews and document review.
Complaint Details
The complaint alleged the facility failed to meet reporting requirements by not providing written incident reports to the resident or responsible party for multiple dates. The investigation substantiated failure to report the incident on 7/14/22. Other dates were found to have no incidents or were properly reported. The allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee failed to report incidents occurred on 7/14/22 to the licensing agency and resident's responsible party within seven days as required by CCR 87211(a)(1). | Type B |
Report Facts
Facility capacity: 93
Census: 78
Deficiency count: 1
Plan of Correction due date: Aug 11, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Joshua Oliver | Business Office Manager | Met with Licensing Program Analyst during investigation |
| Mary Flores | Licensing Program Analyst | Conducted an unannounced subsequent complaint investigation visit on 7/7/23 |
| Rhonwinn Hipolito | Administrator | Facility administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
Jul 21, 2023
Visit Reason
The visit was an unannounced follow-up complaint investigation regarding allegations that staff failed to meet a resident's medical needs, verbally abused a resident, and failed to treat residents with dignity and respect.
Findings
The investigation substantiated the allegations of verbal abuse and failure to treat residents with dignity and respect, resulting in termination of the staff member involved. The allegation that staff failed to meet a resident's medical needs was unsubstantiated due to insufficient evidence.
Complaint Details
The complaint involved allegations that staff verbally abused a resident (S1 verbally abused R11 by screaming and telling the resident to 'Shut up'), failed to treat residents with dignity and respect, and failed to meet a resident's medical needs. The verbal abuse and dignity allegations were substantiated, leading to termination of staff S1. The medical needs allegation was unsubstantiated due to lack of sufficient evidence.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Personal Rights of Residents in All Facilities (a) Residents shall be accorded dignity in their personal relationships with staff, residents, and others, and be free from punishment, humiliation, intimidation, abuse, or other punitive actions. | Type B |
Report Facts
Capacity: 93
Census: 75
Deficiency count: 1
Plan of Correction Due Date: Aug 4, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Executive Director | Interviewed during investigation; provided information on staff termination |
| Tena Herrera | Licensing Program Analyst | Conducted follow-up complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw complaint investigation |
| Rhonnwinn Hipolito | Administrator | Facility administrator named in report |
Inspection Report
Complaint Investigation
Census: 75
Capacity: 93
Deficiencies: 1
Jul 18, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff were not safeguarding residents' belongings at Whittier Glen Assisted Living Facility.
Findings
The investigation substantiated the allegation that residents' personal items, including towels, washcloths, and a jacket, were not consistently returned after laundering. Staff interviews and observations revealed lapses in laundry procedures and lack of inventory tracking, posing potential health and safety risks.
Complaint Details
The complaint was substantiated. The allegation was that staff were not safeguarding residents' belongings, specifically that some personal items taken for laundering were not returned. Evidence included interviews with staff and residents, file reviews, and observations of laundry procedures and resident rooms.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to safeguard resident cash, personal property, and valuables as required by California Code of Regulations Title 22, 87217(b). | Type B |
Report Facts
Capacity: 93
Census: 75
Deficiency Type Count: 1
Plan of Correction Due Date: Jul 28, 2023
Staff Interviewed: 6
Residents Interviewed: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Administrator | Met with during investigation and named in findings |
| Noemi Galarza | Licensing Program Analyst | Conducted the complaint investigation |
| Lisa Hicks | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 1
Jul 7, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-05-12 regarding the facility's failure to meet reporting requirements.
Findings
The investigation found that the facility failed to submit required incident reports to the licensing agency and to the resident or responsible party for several incidents, including failure to report an incident on 7/14/22. The allegation was substantiated based on document review and interviews.
Complaint Details
The complaint alleged the facility failed to meet reporting requirements by not providing written reports to the resident or responsible party for incidents occurring on various dates including January 2020, January 2021, 10/02/21, 05/12/22, 07/01/22, 07/02/22, and 07/12/22. The investigation substantiated the allegation due to failure to report incidents on 7/14/22 to the department and responsible party.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit written incident reports to the licensing agency and responsible party within seven days of occurrence, specifically incidents on 7/14/22. | Type B |
Report Facts
Capacity: 93
Census: 73
Deficiency count: 1
Plan of Correction due date: Jul 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Forsgren | Administrator | Met with Licensing Program Analyst during the investigation and exit interview |
| Tony Vasallo | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 93
Deficiencies: 0
Jun 29, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not properly assess a resident while in care.
Findings
The investigation found insufficient evidence to substantiate the allegation. Interviews and document reviews indicated the assessment was routine, conducted without significant changes in the resident's condition, and complied with regulations. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that the facility performed a pseudo-assessment without a physician, psychiatrist, or the resident's Power of Attorney present, despite prior requests. The resident had an eviction notice and pending court case. The investigation concluded there was not enough evidence to prove the violation occurred, resulting in an unsubstantiated finding.
Report Facts
Capacity: 93
Census: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Gonzalez | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Administrator | Interviewed during investigation |
| Sherrie Similton | Wellness Director | Interviewed during investigation |
| Joshua Oliver | Business Office Manager | Interviewed during investigation and received copy of report |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 0
May 30, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff misrepresented himself as the Administrator and that staff issued an eviction notice to a resident without obtaining licensee’s authority.
Findings
The investigation included interviews with staff, residents, and the Administrator. No evidence was found to corroborate the allegations, and residents and staff denied the claims. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff misrepresenting himself as the Administrator and issuing eviction notices without authority. Interviews and document reviews did not support these claims.
Report Facts
Capacity: 93
Census: 73
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angelica Rea | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation and assisted with visit |
| Lisa Hicks | Licensing Program Manager | Named in report as Licensing Program Manager |
| Rhonwinn Hipolito | Administrator | Facility Administrator interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 73
Capacity: 93
Deficiencies: 1
May 23, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 03/04/2021 regarding the facility's lack of a certified administrator, failure to provide alternative toileting resources for a resident, and untimely renewal of medication.
Findings
The investigation substantiated the allegation that the facility did not have a qualified and currently certified administrator from 2/12/21 to 5/2/21. The allegations regarding failure to provide alternative toileting resources and untimely medication renewal were unsubstantiated based on interviews and file reviews.
Complaint Details
The complaint investigation was substantiated for the allegation that the facility did not have a certified administrator between 2/12/21 and 5/2/21. The allegations that facility staff did not provide alternative toileting resources and did not obtain renewed medication timely were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to maintain a qualified and currently certified administrator as required by CCR 87405(a). | Type B |
Report Facts
Capacity: 93
Census: 73
Deficiency count: 1
Plan of Correction Due Date: Jun 2, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Sherrie Similton | Wellness Director | Met with Licensing Program Analyst during investigation |
| Kimia Ateaiian | Administrator | Named as facility administrator in report header |
| Mona Tirado | Former administrator who left the facility on 2/12/21 | |
| Lori Waters | Interim administrator assisting facility between 2/12/21 and 3/10/21 | |
| Sophia Chan | Administrator appointed in May 2021 |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
May 2, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff were not feeding a resident in care.
Findings
The investigation found that the resident in question occasionally eats meals in the facility but often chooses to eat in their room with self-purchased food. Staff denied the allegation, and most residents could not corroborate it. Observations and file reviews showed the resident was provided meals and a special diet as needed. There was insufficient evidence to substantiate the allegation, so it was deemed unsubstantiated.
Complaint Details
The complaint alleged that a resident (R1) had not received meals in the facility since Easter 2023 (4/9/23). The allegation was unsubstantiated based on interviews with staff and residents, file review, and observations.
Report Facts
Capacity: 93
Census: 65
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
| Sherrie Similton | Wellness Director | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
May 2, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2023-01-24 regarding mishandling of a resident's medications, failure to meet a resident's dietary needs, and inadequate care and supervision of a resident.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Staff and residents interviewed denied the allegations, medication records and meal menus supported compliance, and no documentation of abuse or neglect was found. Therefore, all allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation addressed three allegations: 1) Staff mishandled a resident's medications; 2) Staff did not meet a resident's dietary needs; 3) Staff did not provide adequate care and supervision to a resident. After interviews, record reviews, and observations, none of the allegations were substantiated due to lack of sufficient evidence.
Report Facts
Facility capacity: 93
Resident census: 65
Staff interviewed: 6
Residents interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Sherrie Similton | Wellness Director | Met with Licensing Program Analyst during investigation |
| Kimia Ateaiian | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 93
Deficiencies: 0
Apr 21, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 03/20/2023 concerning inadequate staff supervision, inappropriate staff behavior, unlawful eviction, failure to safeguard resident's personal items, and failure to provide meals to a resident.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Interviews with staff and residents, review of documentation including eviction notices, police reports, and facility records did not corroborate the claims. The resident involved was moved out of the facility following safety concerns.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included inadequate staff supervision leading to assault, staff speaking inappropriately to a resident, unlawful eviction practices, failure to safeguard resident's personal items, and failure to provide meals. After interviews and document review, there was not enough evidence to prove the allegations.
Report Facts
Capacity: 93
Census: 68
Eviction notice dates: 2
Knife length: 6
Value of missing items: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bennette Pena | Licensing Program Analyst | Conducted the complaint investigation |
| David Sicairos | Licensing Program Manager | Oversaw the complaint investigation |
| Michael Forsgren | Operations Manager | Spoke with Licensing Program Analyst by phone during investigation |
| Sherrie Similton | Wellness Director | Met with Licensing Program Analyst during inspection |
| Rhonnwinn Hipolito | Administrator | Facility administrator mentioned in report |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
Apr 18, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff were overmedicating a resident in care.
Findings
The investigation found no preponderance of evidence to substantiate the allegation that a resident was overmedicated or in a coma-like state due to facility staff actions. Staff and residents interviewed denied the allegation, medication records showed adherence to physician orders, and the Nurse Practitioner did not confirm the claim.
Complaint Details
The complaint alleged that Resident #1 was overmedicated and in a coma-like state for one to two weeks starting 7/12/22, and that facility staff were aware but did not act. Interviews with staff and residents, review of medication records, and NP interview did not support the allegation. The complaint was unsubstantiated.
Report Facts
Capacity: 93
Census: 65
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 93
Deficiencies: 0
Apr 14, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 04/10/2023 regarding insufficient notice of rate changes, interference with the resident council book, and failure to safeguard residents' records.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews with staff, residents, and administrators denied the allegations, and documentation supported that residents received proper notice of rate changes, the council book was not interfered with, and residents' records were safeguarded.
Complaint Details
The complaint was unsubstantiated. Allegations included insufficient notice prior to rate changes, interference with the resident council book, and failure to safeguard residents' records. Interviews and documentation did not support these allegations.
Report Facts
Capacity: 93
Census: 66
Date complaint received: Apr 10, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ashley Calderon | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Forsgren | Operations Manager | Interviewed regarding allegations and facility operations |
| Rhonwinn Hipolito | Administrator | Interviewed regarding allegations and facility operations |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
Apr 13, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that residents' medications were being stolen by staff while in care.
Findings
After interviews with staff and residents, and review of medication records, there was no evidence to substantiate the allegation of medication theft. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that residents' medications were being stolen by staff. The investigation included interviews with staff and residents, review of medication administration records, and found no evidence of medication theft. The complaint was unsubstantiated.
Report Facts
Capacity: 93
Census: 65
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Glenn Trueman | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during the investigation |
| Wei Siew Ho | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 93
Deficiencies: 0
Apr 13, 2023
Visit Reason
An unannounced complaint investigation was conducted regarding an allegation that staff were not providing a safe environment for residents in care, specifically that a resident was being threatened by another resident due to his religion.
Findings
The investigation included interviews with residents and staff, review of documentation, and a facility tour. Staff and residents denied the allegation, and there was insufficient evidence to substantiate the claim. The incident involving a resident hitting another with a wheelchair was determined to be accidental. The allegation was deemed unsubstantiated.
Complaint Details
The complaint alleged that a resident was being threatened by another resident due to his religion. Interviews with staff and residents denied the allegation. An incident involving a resident hitting another with a wheelchair was reported and investigated, with no arrests made. The allegation was unsubstantiated due to lack of evidence.
Report Facts
Facility capacity: 93
Census: 66
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bennette Pena | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation |
| David Sicairos | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 93
Deficiencies: 0
Mar 28, 2023
Visit Reason
An unannounced complaint investigation was conducted to determine the validity of allegations including the facility not preventing residents from becoming intoxicated, a resident threatening others with a knife, knives being accessible to residents, and the facility not providing a safe environment.
Findings
The investigation found that although some allegations occurred, such as a resident threatening others with a knife and intoxication issues with one resident, the facility took appropriate actions including eviction notices and reporting to authorities. Other allegations were not corroborated by residents or staff, and the facility was found to maintain locked kitchen access and a generally safe environment. Overall, the allegations were unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included intoxication, resident threatening others with a knife, accessibility of knives, and unsafe environment. The facility had taken steps such as eviction notices and reporting to Community Care Licensing. Residents and staff interviews did not corroborate most allegations except the isolated knife incident involving resident R1.
Report Facts
Facility capacity: 93
Census: 62
Police officers involved: 8
Eviction notice days: 30
Eviction notice days: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Operations Manager | Interviewed during investigation and provided information about facility policies and incidents |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 93
Deficiencies: 0
Mar 27, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 09/19/2022 regarding communication issues with resident representatives, forced signing of inappropriate documents, and failure to protect residents from other residents.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and most residents denied the allegations, and documentation showed timely incident reporting and appropriate staff response to disruptive behavior. Therefore, all allegations were unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to communicate timely with a resident's representative, forcing a resident or representative to sign inappropriate documents, and failure to protect residents from other residents. Interviews with staff and residents did not corroborate these allegations, and documentation supported appropriate facility actions.
Report Facts
Capacity: 93
Census: 64
Incident dates: Incidents involving resident R2 occurred on 09/03/2022 and 09/07/2022
Eviction notice date: Resident R2 was served an eviction notice on 09/19/2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Diana Marquez | Business Office Manager | Met with the Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 1
Mar 21, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by complaints received on 2023-02-09 regarding staff not keeping accurate accounting records for residents and staff retaliation against individuals cooperating with complaint investigations.
Findings
The investigation substantiated that the facility failed to maintain accurate accounting records for Resident #1 due to lack of documentation for certain charges, posing a potential health and safety risk. The allegation of staff retaliation against individuals cooperating with complaint investigations was unsubstantiated based on interviews with staff and residents.
Complaint Details
The complaint investigation included two allegations: 1) Staff are not keeping accurate accounting records for residents in care, which was substantiated; 2) Staff retaliate against individuals who cooperate with complaint investigations, which was unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to maintain adequate financial records as required by CCR 87213, evidenced by inaccurate documentation of charges on Resident #1's account. | Type B |
Report Facts
Capacity: 93
Census: 65
Charges: 7.4
Charges: 203.23
Plan of Correction Due Date: Mar 31, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation |
| Kimia Ateaiian | Administrator | Facility administrator named in the report |
| S6 | Business Manager | Former Business Manager responsible for managing resident account files, no longer employed at the facility |
Inspection Report
Complaint Investigation
Census: 65
Capacity: 93
Deficiencies: 0
Mar 17, 2023
Visit Reason
The visit was an unannounced case management visit conducted in response to an incident report received by the licensing agency on 2023-03-16 involving a resident brandishing a knife and causing injury.
Findings
The investigation found that Resident #1 became aggressive and brandished a 6-inch knife at other residents, resulting in a laceration to Resident #1's nose. Police and paramedics responded, and Resident #1 was transported to the hospital and later returned to the facility. No immediate health or safety concerns or deficiencies were observed during the visit.
Complaint Details
The complaint involved Resident #1 being inebriated and aggressive, brandishing a knife at other residents, causing injury. The police cited Resident #1 for assault but did not take them into custody due to wheelchair use. Resident #1 was issued a 30-day eviction notice prior to the incident and a 3-day eviction notice after the incident, which is under review with the licensing agency.
Report Facts
Capacity: 93
Census: 65
Knife length: 6
Eviction notice duration: 30
Eviction notice duration: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rhonwinn Hipolito | Executive Director | Met with Licensing Program Analyst during visit and involved in incident management |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during visit and involved in incident management |
Inspection Report
Census: 65
Capacity: 93
Deficiencies: 4
Mar 17, 2023
Visit Reason
An unannounced case management visit was conducted to cite deficiencies found during a health and safety check at the assisted living facility.
Findings
Multiple deficiencies were observed including unclean and odorous resident restrooms, dirty carpets, inaccessible call system due to furniture placement, soiled linens, and uncovered trash bins containing soiled briefs, posing potential health, safety, and personal rights risks to residents.
Severity Breakdown
Type B: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to maintain 2 of 5 resident restrooms clean and odorless, and 1 of 5 resident room carpets clean. | Type B |
| Failed to maintain trash bins with lids for disposal of soiled adult briefs in resident room. | Type B |
| Failed to allow safe access to the call signal system in a resident's room due to furniture placement. | Type B |
| Failed to ensure a resident had clean blankets on their bed. | Type B |
Report Facts
Deficiencies cited: 4
Plan of Correction Due Date: Mar 31, 2023
Plan of Correction Due Date: Mar 21, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rhonwinn Hipolito | Executive Director | Met during the inspection and involved in discussion of deficiencies. |
| Michael Forsgren | Operations Manager | Met during the inspection and involved in discussion of deficiencies. |
| Valeria Maldonado | Licensing Evaluator | Conducted the inspection and signed the report. |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 93
Deficiencies: 1
Mar 14, 2023
Visit Reason
An unannounced complaint investigation was conducted following allegations including a staff member borrowing money from a resident and not repaying it, inadequate food quantity, delayed response to call buttons, staff retaliation, safety of personal possessions, privacy violations, and untimely medical attention.
Findings
The investigation substantiated the allegation that a staff member borrowed money from a resident and did not repay it, violating the facility's plan of operation. All other allegations were found unsubstantiated due to lack of preponderance of evidence based on interviews, observations, and document reviews.
Complaint Details
The complaint investigation was triggered by an allegation that a facility staff member asked a resident to lend them money and never paid it back. The allegation was substantiated. Other allegations including inadequate food, delayed call button response, staff retaliation, safety of possessions, privacy violations, and untimely medical attention were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| S1 borrowed money from R1 and did not return their money, violating the facility's staff handbook and plan of operation. | Type B |
Report Facts
Capacity: 93
Census: 63
Deficiency count: 1
Plan of Correction Due Date: Mar 23, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation |
| Rhonwinn Hipolito | Administrator | Facility administrator mentioned in report |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 93
Deficiencies: 0
Mar 14, 2023
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 03/13/2023 regarding staff participation in a resident council meeting without resident council approval.
Findings
The investigation found that staff member S1 was invited by the resident council president to attend the meeting as a guest, and interviews with staff and residents did not corroborate the allegation. The complaint was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The allegation was that staff participated in the resident council meeting without resident council approval. Interviews with five staff members and six residents, including the resident council president, indicated that the staff member was invited to attend the meeting. The allegation was unsubstantiated.
Report Facts
Capacity: 93
Census: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Michael Forsgren | Operations Manager | Met with the Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 93
Deficiencies: 1
Mar 10, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2023-01-17 regarding allegations that the facility did not notify Licensing of COVID positives in a timely manner, did not follow isolation/quarantine procedures for COVID positive residents, and did not notify residents of the COVID outbreak in a timely manner.
Findings
The investigation substantiated the allegation that the facility failed to notify Licensing of COVID positives in a timely manner, with evidence showing delays in reporting positive cases from December 2022. The allegations regarding failure to follow isolation/quarantine procedures and failure to notify residents of the outbreak were found unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was substantiated for the allegation that the facility did not notify Licensing of COVID positives in a timely manner. The allegations that the facility did not follow isolation/quarantine procedures and did not notify residents of the COVID outbreak in a timely manner were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to notify Licensing of COVID positives for 12/8-12/9/22 in a timely manner, posing a potential health and safety risk to residents. | Type B |
Report Facts
Capacity: 93
Census: 63
Staff COVID positives not reported timely: 3
Resident COVID positives not reported timely: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Michael Forsgren | Operations Manager | Facility representative met during the investigation |
| Kimia Ateaiian | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 93
Deficiencies: 0
Mar 2, 2023
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that facility staff stole a resident's personal property.
Findings
The investigation included interviews with residents and staff and a tour of the facility. The allegation was unsubstantiated due to lack of preponderance of evidence, with staff denying the incident and most residents unable to corroborate the claim.
Complaint Details
The complaint alleged that facility staff stole a resident's personal property by entering the resident's room and taking documents. Staff denied the allegation, and the investigation found no conclusive evidence to substantiate the claim.
Report Facts
Capacity: 93
Census: 64
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Erik Zaragoza | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Diana Marquez | Business Office Manager | Met with investigators during the visit |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 93
Deficiencies: 0
Feb 2, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 06/30/2022 concerning staff not honoring resident privacy during resident council meetings, failure to assist a resident with medical treatment after a fall, failure to report a resident's incident per Title 22 reporting requirements, and falsifying incident reports.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations. Interviews with residents, staff, and the Executive Director, along with document reviews, indicated that resident privacy was maintained during council meetings, medical assistance was provided appropriately, incident reports were created and submitted timely, and no falsification of reports was evident.
Complaint Details
The complaint investigation was unannounced and addressed four allegations: 1) staff not honoring resident privacy during resident council meetings, 2) staff not assisting a resident with medical treatment after a fall, 3) failure to report a resident's incident per Title 22 reporting requirements, and 4) falsifying incident reports. All allegations were found to be unsubstantiated.
Report Facts
Capacity: 93
Census: 60
Complaint Control Number: 28
Incident report submission timeframe: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during investigation and exit interview |
| Pamela Junge | Executive Director | Reviewed and approved unusual incident report dated 7/1/22 |
Inspection Report
Complaint Investigation
Capacity: 93
Deficiencies: 1
Feb 2, 2023
Visit Reason
An unannounced case management visit was conducted to note deficiencies during the investigation of complaint #28-AS-202206300153013 regarding a violation of resident personal rights.
Findings
The facility was found to have violated personal rights by including resident #1's medical diagnosis and directives in Resident Council Meeting minutes, which were provided to residents upon request, breaching confidentiality requirements under Title 22 regulations.
Complaint Details
Investigation of complaint #28-AS-202206300153013 found substantiated violation related to confidentiality breach in Resident Council Meeting minutes.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not ensure medical diagnosis/directives were maintained confidential for residents in care, violating personal rights. | Type A |
Report Facts
Facility capacity: 93
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Forsgren | Operation Manager | Met during exit interview and involved in discussion of findings |
| Mary G Flores | Licensing Program Analyst | Conducted the unannounced case management visit and authored the report |
| Tony Vasallo | Supervisor | Named as supervisor in the report |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 93
Deficiencies: 2
Jan 18, 2023
Visit Reason
An unannounced complaint investigation was conducted to determine the validity of allegations including failure to conduct a needs appraisal upon admission and lack of a certified administrator, as well as other complaints such as illegal eviction, staff retaliation, denial of resident participation in care planning, failure to provide nutritious meals, and failure to provide requested documents.
Findings
The investigation substantiated that the facility did not complete a pre-admission appraisal prior to admitting a resident and that the facility did not have a certified administrator at the time of employment. Other allegations including illegal eviction, staff retaliation, denial of resident participation in care planning, failure to provide nutritious meals, and failure to provide requested documents were found unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was substantiated for allegations that staff did not ensure a needs appraisal was conducted upon admission and that the facility did not have a certified administrator. Other allegations including illegal eviction, staff retaliation, denial of resident participation in care planning, failure to provide nutritious meals, and failure to provide requested documents were unsubstantiated.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility did not perform a pre-admission appraisal prior to admitting resident R1. | Type B |
| Facility employed an Operations Manager without a residential care facility administrator certificate prior to employment. | Type B |
Report Facts
Resident balance owed: 4862.42
Monthly care fee: 1725
Monthly care fee paid: 1300
Deficiencies cited: 2
Facility capacity: 93
Facility census: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation. |
| Michael Forsgren | Operations Manager | Interviewed during investigation; involved in findings regarding administrator certification and resident care. |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation. |
Inspection Report
Annual Inspection
Census: 56
Capacity: 93
Deficiencies: 0
Dec 19, 2022
Visit Reason
The inspection was an unannounced required annual inspection focused on the Infection Control Domain at Whittier Glen Assisted Living Facility.
Findings
The facility was found to be clean, sanitary, and in good repair with no deficiencies cited. Infection control practices, physical plant conditions, and safety equipment were all compliant with regulations.
Report Facts
Resident files reviewed: 6
Staff files reviewed: 4
Medication records reviewed: 6
Water temperature range (F): 105
Water temperature range (F): 120
Non-perishable food supply (days): 7
Perishable food supply (days): 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the inspection and discussed infection control practices |
| Michael Forsgren | Operations Manager | Met with Licensing Program Analyst during inspection and received report |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 93
Deficiencies: 0
Nov 7, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 03/18/2022 regarding medication mismanagement, failure to administer medications per doctor's orders, and lack of dignity in resident treatment.
Findings
Based on interviews, observations, and file reviews, there was insufficient evidence to substantiate the allegations. No deficiencies were observed or cited during the visit, and the allegations were determined to be unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included facility mismanaging resident's medications, staff not administering medications per doctor's orders, and staff not treating residents with dignity. Interviews with residents and staff found no knowledge or evidence supporting these claims.
Report Facts
Capacity: 93
Census: 54
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Maldonado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Itzayana Barba | Operations Manager | Met with during exit interview |
| Pamela Junge | Executive Director | Interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 54
Capacity: 93
Deficiencies: 0
Nov 3, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted due to allegations received on 12/24/2020 regarding resident injury and unmet resident needs at Whittier Glen Assisted Living Facility.
Findings
The investigation found no preponderance of evidence to substantiate the allegations that a resident sustained a facial injury from an unwitnessed fall or that staff neglected resident needs. Interviews with staff and residents, as well as file reviews, did not corroborate the allegations, resulting in an unsubstantiated determination.
Complaint Details
The complaint involved allegations that a resident sustained an injury while in care and that staff did not ensure the resident's needs were met. The investigation included interviews with residents and staff, review of incident reports and care plans, and concluded the allegations were unsubstantiated.
Report Facts
Staff interviewed: 5
Residents interviewed: 5
Incident reports reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Pamela Junge | Administrator | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 93
Deficiencies: 0
Oct 27, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that residents' diapering and hygiene needs were not being met at Whittier Glen Assisted Living Facility.
Findings
The investigation found that the facility staff alternated diapering needs every two hours and provided hygiene needs to residents requiring full-service care. Despite the allegations, there was insufficient evidence to substantiate neglect or lack of supervision regarding diapering and hygiene needs.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included neglect/lack of supervision regarding residents' diapering and hygiene needs. The investigation included interviews with staff and review of resident care plans and monitoring programs. Both allegations were found to be unsubstantiated.
Report Facts
Capacity: 93
Census: 55
Allegations: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth Ceniceros | Licensing Program Analyst (LPA)/Retired Annuitant (RA) | Conducted the complaint investigation and unannounced visit |
| Pamela Jung | Administrator | Facility administrator met during the investigation |
| Angelica Rea | Licensing Program Analyst | Conducted initial 10-Day visit and signed report |
| Katie McDonald | Medication Technician | Received a copy of the complaint report during exit interview |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 93
Deficiencies: 0
Sep 13, 2022
Visit Reason
Unannounced complaint investigation visit conducted due to allegations that the facility mismanaged resident medications, staff did not administer medications per doctor's orders, and staff did not treat residents with dignity.
Findings
Based on interviews with residents and staff, review of records, and observations, there was insufficient evidence to substantiate the allegations. Residents and staff reported no knowledge or incidents of medication mismanagement or improper administration, and most residents stated staff treated them with dignity.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included medication mismanagement, failure to administer medications per doctor's orders, and lack of dignity in resident treatment. Interviews with residents (R2-R7) and staff (S1-S4) found no supporting evidence. Resident #1 was no longer at the facility and was able to self-administer medications as per physician's report.
Report Facts
Capacity: 93
Census: 55
Residents interviewed: 6
Staff interviewed: 4
PRN medication duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pamela Junge | Executive Director | Met with Licensing Program Analyst during investigation and involved in medication management allegation |
| Valeria Maldonado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Oversaw complaint investigation |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 93
Deficiencies: 0
Sep 1, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 08/23/2022 regarding facility upkeep, resident beverage provision, and staff neglect resulting in resident assaults.
Findings
The investigation found no evidence to substantiate the allegations. The facility was observed to be clean, residents reported receiving beverages, and no physical assaults between residents were witnessed. The allegations were deemed unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included the facility being unkept, residents not receiving beverages, and staff neglect leading to resident assaults. Interviews and observations did not corroborate these claims.
Report Facts
Capacity: 93
Census: 50
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angelica Rea | Licensing Program Analyst | Conducted the complaint investigation visit |
| Pamela Junge | Executive Director | Met with Licensing Program Analyst during the investigation |
| Lisa Hicks | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 93
Deficiencies: 0
Aug 25, 2022
Visit Reason
An unannounced complaint investigation was conducted regarding the allegation that a resident's bathroom is not wheelchair accessible.
Findings
The investigation found that although one resident's wheelchair did not fit into their bathroom, staff accommodated the resident's needs and other residents using wheelchairs were able to access their bathrooms. The allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that Resident #1's bathroom was not wheelchair accessible. Staff and most residents denied the allegation. Resident #1 was able to ambulate with a walker to enter the bathroom and staff provided accommodations. The allegation was unsubstantiated.
Report Facts
Facility capacity: 93
Census: 50
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Named in report signature and oversight |
| Pamela Junge | Administrator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 93
Deficiencies: 0
Aug 25, 2022
Visit Reason
The visit was an unannounced complaint investigation regarding the allegation that the facility is retaining residents who threaten the safety of other residents while in care.
Findings
The investigation found that staff and some residents denied the allegation. Resident R2 was noted to shout and scream, and an incident report showed R2 threw a facility computer. However, there was no evidence that R2 or R3 assaulted other residents or that staff ignored such behavior. The allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that residents R2 and R3 threaten the safety of other residents and that the facility does nothing about it. Interviews with six staff members denied the allegation, and four of seven residents interviewed could not corroborate it. Incident reports and interviews showed no assaults occurred or were ignored. The allegation was unsubstantiated.
Report Facts
Staff interviewed: 6
Residents interviewed: 7
Incident report date: Jul 16, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Pamela Junge | Administrator | Met with Licensing Program Analyst during investigation and exit interview |
| Fernando Fierros | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 50
Capacity: 93
Deficiencies: 1
Aug 25, 2022
Visit Reason
The visit was a case management inspection conducted after discovering deficiencies during a complaint investigation related to resident care and supervision.
Findings
The facility retained a resident whose primary need for care and supervision was due to ongoing behavior caused by a mental disorder that upset the general resident group, posing a potential health and safety risk.
Complaint Details
The visit was triggered by a complaint investigation for control number 28-AS-20220720132522.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| No resident shall be accepted or retained if the resident's primary need for care and supervision results from an ongoing behavior caused by a mental disorder that would upset the general resident group; this was not met as evidenced by Resident #1's ongoing behavior of shouting and yelling at staff and residents. | Type B |
Report Facts
Capacity: 93
Census: 50
Plan of Correction Due Date: Sep 9, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Fernando Fierros | Supervisor | Supervisor overseeing the inspection |
| Pamela Junge | Administrator | Facility administrator met during the exit interview |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 93
Deficiencies: 0
Aug 4, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff were over medicating residents.
Findings
The investigation included review of resident medication records and interviews with residents, staff, relatives, and a hospice nurse. All evidence indicated medications were administered correctly and the allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff were over medicating residents. The investigation found no evidence to substantiate the allegation, and it was determined to be unsubstantiated.
Report Facts
Capacity: 93
Census: 52
Number of residents' medications reviewed: 7
Number of residents interviewed: 4
Number of staff interviewed: 4
Number of relatives interviewed: 2
Number of hospice nurses interviewed: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alberto Lopez | Licensing Program Analyst | Conducted the complaint investigation and unannounced visit |
| Pamela Junge | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Kimia Ateaián | Administrator | Facility administrator named in the report |
| Stefanie Coronel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 93
Deficiencies: 0
Jul 27, 2022
Visit Reason
An unannounced complaint investigation was conducted to determine the validity of an allegation that facility staff was interfering with a resident's ability to shower.
Findings
The investigation found that although the resident's shower grab bar in room 106 was high, alternative showers with lower grab bars were available. The resident was allowed to use these showers and was offered to move to a ready room with a similar grab bar, but had not moved due to a fee and concerns about a loose grab bar. Staff denied interfering with the resident's ability to shower. The allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that facility staff interfered with a resident's ability to shower. The investigation included interviews with staff, the resident, and the resident's roommate, as well as tours of relevant rooms. The allegation was found unsubstantiated.
Report Facts
Capacity: 93
Census: 52
Fee: 500
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation |
| Pamela Junge | Executive Director | Interviewed during the investigation |
| Kimia Ateaián | Administrator | Facility administrator named in the report |
| Stefanie Coronel | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 93
Deficiencies: 0
Jul 14, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility overcharged a resident.
Findings
The investigation found that Resident #1 had been hospitalized and moved out, but was billed $1,882 for July 2022. The Executive Director clarified that the resident was only responsible for an outstanding balance of $182.28 due to past charges, and would not be charged room and board for July. There was insufficient evidence to substantiate the allegation, so it was deemed unsubstantiated.
Complaint Details
The complaint was that the facility overcharged a resident. The allegation was unsubstantiated due to lack of sufficient evidence.
Report Facts
Outstanding balance: 182.28
Initial billed amount: 1882
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Sicairos | Licensing Program Analyst | Conducted the complaint investigation visit |
| Pamela Junge | Executive Director | Met with Licensing Program Analyst and provided information regarding billing |
| Stefanie Coronel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 53
Capacity: 93
Deficiencies: 2
Jul 6, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to multiple allegations received on 2021-11-22 regarding staff not abiding by admission agreements, failure to advise residents of complaints filed against the facility, and residents being charged for services not received.
Findings
The investigation found that the allegation regarding failure to provide a copy of the admission agreement was substantiated due to inadequate record keeping and failure to provide requested documents. Other allegations, including staff not advising residents of complaints and residents being charged for services not received, were unsubstantiated due to lack of sufficient evidence.
Complaint Details
The complaint investigation was triggered by allegations that staff did not abide by admission agreements, failed to advise residents of complaints filed against the facility, and charged residents for services not received. The investigation was unannounced and conducted by Licensing Program Analysts Jose Villalobos and Mary Flores. The allegations regarding failure to provide admission agreements and inadequate record keeping were substantiated, while other allegations were unsubstantiated due to insufficient evidence.
Severity Breakdown
Type B: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide a copy of the signed and dated current admission agreement and all subsequent modifications to the resident or resident's representative upon request. | Type B |
| Admission agreements did not specify payment provisions including a comprehensive description of items and services provided; specifically, the admission agreement lacked a breakdown of the resident's rate calculation. | Type B |
Report Facts
Capacity: 93
Census: 53
Plan of Correction Due Date: Jul 22, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted complaint investigation and cited deficiencies |
| Mary Flores | Licensing Program Analyst | Conducted complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw complaint investigation |
| Pamela Junge | Administrator | Facility administrator involved in investigation and receipt of report |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 93
Deficiencies: 0
Jun 16, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that a resident was left in soiled diapers for an extended amount of time and that staff did not communicate with the authorized representative.
Findings
The investigation found insufficient evidence to substantiate the allegations. Interviews with staff and residents, as well as review of resident records, indicated the resident did not require continence assistance and that staff attempted to notify the responsible party about a room change. Therefore, the allegations were unsubstantiated.
Complaint Details
The complaint was unsubstantiated based on interviews, file reviews, and lack of corroborating evidence. The resident was observed in a soiled diaper on 06/05/22, but staff denied the allegation and records showed the resident was continent and independent. The responsible party was notified of a room change via voicemail and phone call, but there was insufficient evidence to prove failure to communicate.
Report Facts
Capacity: 93
Census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Sicairos | Licensing Program Analyst | Conducted the complaint investigation |
| Pamela Junge | Executive Director | Interviewed during the investigation |
| Stefanie Coronel | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 93
Deficiencies: 0
Apr 20, 2022
Visit Reason
An unannounced complaint investigation visit was conducted to determine the validity of an allegation that the facility was not following doctor's orders.
Findings
The investigation found that the facility was applying baby powder to a resident despite an alleged order to stop, but there was no documentation supporting this order. The facility stopped using the powder per the responsible party's request. Additionally, the facility was alleged to not provide PRN Tylenol medication when needed, but medication records showed it was administered. The allegations were unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged the facility was not following doctor's orders, specifically regarding the use of baby powder on Resident 1 and failure to provide PRN Tylenol medication. The investigation was unsubstantiated.
Report Facts
Facility capacity: 93
Census: 59
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luis Mora | Licensing Program Analyst | Conducted the complaint investigation visit |
| Pamela Jungi | Executive Director | Met with Licensing Program Analyst during investigation |
| Stefanie Coronel | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 93
Deficiencies: 0
Apr 14, 2022
Visit Reason
The inspection was conducted as a complaint investigation following an allegation that a resident sustained an injury from a fall while in care.
Findings
The investigation found that the resident was intoxicated and sustained a bump on the forehead, but staff and resident interviews, as well as file reviews, did not support the allegation of lack of supervision. There was insufficient evidence to substantiate the complaint, resulting in an unsubstantiated finding.
Complaint Details
The complaint alleged that Resident #1 sustained an injury from a fall while intoxicated due to lack of supervision. The allegation was unsubstantiated after interviews with staff and residents, review of incident reports and resident files, and observation. No evidence showed lack of supervision or violation of regulations.
Report Facts
Capacity: 93
Census: 62
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Pamela Junge | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 93
Deficiencies: 2
Mar 23, 2022
Visit Reason
The inspection was conducted as a complaint investigation following an allegation that staff were not administering medication as prescribed.
Findings
The investigation substantiated the allegation that medications were not administered as prescribed to residents. Specific medications such as Acetaminophen and Loratadine were not given or documented properly, posing an immediate health and safety risk.
Complaint Details
The complaint was substantiated based on interviews and record reviews. Staff were observed not administering medications as prescribed, and medication logs showed discrepancies. The investigation was conducted by Licensing Program Analyst Nune Margaryan.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to provide Acetaminophen 325 mg, 500 mg, and 650 mg to Resident 1 as prescribed. | Type A |
| Facility failed to provide Loratadine 10 mg to Resident 2 as prescribed. | Type A |
Report Facts
Facility capacity: 93
Census: 68
Deficiencies cited: 2
Plan of Correction due date: Mar 24, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nune Margaryan | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Sophia Chan | Executive Director | Met with Licensing Program Analyst during the inspection |
| Kimia Ateaiian | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 93
Deficiencies: 1
Mar 21, 2022
Visit Reason
The inspection visit was conducted as a health and safety check related to complaint #28-AS-20220318093921.
Findings
The Licensing Program Analyst observed that water temperatures in multiple facility locations exceeded the safe maximum of 120°F, posing a health and safety risk to residents. A deficiency was cited requiring correction.
Complaint Details
The visit was complaint-related, triggered by complaint #28-AS-20220318093921. The deficiency was substantiated as the water temperature exceeded safe limits.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Water temperature controls did not maintain hot water temperature between 105°F and 120°F, with observed temperatures ranging from 125.6°F to 130.6°F in various areas. | Type A |
Report Facts
Water temperature: 130.6
Water temperature: 127.4
Water temperature: 129
Water temperature: 125.6
Deficiency count: 1
Plan of Correction due date: Mar 22, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Angelica Rea | Licensing Program Analyst | Observed water temperature deficiencies and created the report |
| Lisa Hicks | Supervisor | Named as supervisor in the report |
| Kimia Ateaián | Administrator | Facility administrator to whom the deficiency and appeal rights were provided |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 93
Deficiencies: 0
Mar 10, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to multiple allegations received on 2022-03-02 concerning resident care, notification of incidents, medical attention, record keeping, staffing adequacy, and facility maintenance at Whittier Glen Assisted Living Facility.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. Staff interviews, resident interviews, and document reviews indicated that care and supervision were provided, authorized representatives were notified timely, medical attention was given as needed, records were maintained properly, staffing was adequate, and the sliding door was functional.
Complaint Details
The complaint investigation was unsubstantiated for all allegations including resident fall, failure to notify authorized representative, failure to seek timely medical attention, inadequate record keeping, inadequate staffing, and sliding door disrepair.
Report Facts
Capacity: 93
Census: 67
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Sophia Chan | Administrator | Met with Licensing Program Analyst during investigation |
| Brooke Lamotte | Wellness Director | Met with Licensing Program Analyst during investigation |
| Fernando Fierros | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 93
Deficiencies: 1
Mar 10, 2022
Visit Reason
An unannounced complaint investigation was conducted due to a complaint regarding an incident report that was not submitted within the required time frame.
Findings
The Licensing Program Analyst found that an incident involving Resident #1 on 2022-03-01 was not reported to licensing within the required seven days, as it was only provided on 2022-03-10, posing a potential health and safety risk.
Complaint Details
The complaint investigation found the incident report regarding Resident #1 was not reported within the required time. The incident occurred on 2022-03-01 and was reported late on 2022-03-10.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to submit a written incident report to the licensing agency within seven days of the occurrence of an incident threatening the welfare, safety, or health of a resident. | Type B |
Report Facts
Deficiency Type: 1
Plan of Correction Due Date: Mar 25, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation and issued the citation |
| Fernando Fierros | Supervisor | Supervisor overseeing the investigation |
| Sophia Chan | Administrator | Facility administrator who received the Facility Evaluation Report and Appeal Rights |
Inspection Report
Census: 55
Capacity: 93
Deficiencies: 0
Jan 20, 2022
Visit Reason
The visit was an informal conference held to discuss facility staffing issues, specifically addressing a staffing shortage incident that occurred on 1/15/2022.
Findings
No deficiencies were issued during the meeting. The facility explained the staffing shortage was a one-time incident due to miscommunication and COVID-19 positive staff, and steps were taken to improve staffing coverage.
Report Facts
Capacity: 93
Census: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sophia Chan | Facility Administrator | Met during the visit and discussed staffing issues |
| Brooke Lamaonte | Wellness Director | Met during the visit and discussed staffing issues |
| Jose Villalobos | Licensing Program Analyst | Present during the informal conference |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 93
Deficiencies: 1
Jan 5, 2022
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that a staff member was stealing a resident's funds.
Findings
The investigation substantiated that Staff #1 was responsible for unauthorized spending from Resident #1's bank account without the resident's knowledge. The facility does not manage the resident's finances, yet Staff #1 was able to access the account. Staff #1 resigned following the discovery.
Complaint Details
The complaint was substantiated based on interviews, file reviews, and evidence showing unauthorized purchases made by Staff #1 from Resident #1's bank account. Staff #1 resigned and the facility took corrective actions including staff removal and training.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87468.1 Personal Rights of Residents in All Facilities (a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions. Resident #1 had been financially abused by Staff #1 leading to non-authorized purchases made to Resident #1's bank account, posing a potential health and safety risk. | Type B |
Report Facts
Capacity: 93
Census: 56
Deficiency count: 1
Plan of Correction Due Date: Jan 21, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Kimia Ateaiian | Administrator | Facility administrator involved in the investigation |
| Christina Gonzalez | Staff | Staff member interviewed during the investigation |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 93
Deficiencies: 0
Dec 27, 2021
Visit Reason
An unannounced complaint investigation visit was conducted to address multiple allegations including untimely response to assistance requests, residents in wheelchairs blocking exitways, facility temperature issues, medication delays, and unsafe food preparation.
Findings
The investigation included interviews with residents, staff, and the executive director, as well as facility observations. All allegations were found to be unsubstantiated due to lack of preponderance of evidence, with residents and staff denying the claims and observations supporting timely assistance, clear exitways, appropriate facility temperature, timely medication administration, and safe food preparation practices.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included requests for assistance not being timely responded to, residents in wheelchairs blocking exitways, the facility being cold, medication not provided timely, and unsafe food preparation. Interviews and observations did not support these allegations.
Report Facts
Capacity: 93
Census: 55
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Wong | Licensing Program Analyst | Conducted the complaint investigation visit |
| Sophia Chan | Executive Director | Met with investigator and provided information during the visit |
| Tanya Ramos | Caregiver | Met with investigator and provided information during the visit |
| Kimia Ateaián | Administrator | Facility administrator present during exit interview |
Inspection Report
Annual Inspection
Census: 54
Capacity: 93
Deficiencies: 0
Oct 20, 2021
Visit Reason
An unannounced annual visit was conducted with a focus on infection control to evaluate compliance with regulations and facility conditions.
Findings
The facility was found to be clean, sanitary, and in good repair with no deficiencies cited. Infection control practices, physical plant conditions, and safety equipment were all in compliance with regulations.
Report Facts
Resident files reviewed: 5
Staff files reviewed: 5
Water temperature range (F): 105
Water temperature range (F): 120
Non-perishable food supply (days): 7
Perishable food supply (days): 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the inspection and discussed infection control practices |
| Sophia Chan | Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 93
Deficiencies: 0
Apr 25, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the facility failed to seek timely medical attention for a resident.
Findings
The investigation found that the resident fell while trying to reach for their phone and did not complain of pain immediately after. Facility staff assessed the resident and did not observe signs requiring emergency care at that time. The resident later received medical treatment at an orthopedic appointment and hospital. Based on interviews and document reviews, there was insufficient evidence to substantiate the allegation, and the complaint was unsubstantiated.
Complaint Details
The complaint alleged that facility staff failed to seek timely medical attention for a resident who fell and injured their arm. The investigation included interviews with staff, residents, and family members, as well as review of medical and hospital documents. The allegation was found to be unsubstantiated due to lack of sufficient evidence.
Report Facts
Facility capacity: 93
Census: 64
Medication dosage: 100
Medication dosage: 500
Medication dosage: 600
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alma Gonzalez | Licensing Program Analyst | Conducted the complaint investigation and telephonic interviews |
| Rebecca Orendain | Licensing Program Manager | Named as Licensing Program Manager on the report |
| Kimia Ateaiian | Administrator | Facility administrator named in the report |
| Aide Alba | Wellness Director | Interviewed during the investigation and assisted with resident assessment |
| Hannah Bolster | Med Tech | Interviewed regarding resident fall and response |
| Ryan Gallion | Operations Manager | Interviewed by Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 52
Capacity: 93
Deficiencies: 0
Jan 6, 2021
Visit Reason
The inspection was an unannounced complaint investigation triggered by allegations received on 12/28/2020 regarding staff smoking marijuana inside the facility and residents being unable to communicate with family members.
Findings
The investigation found no corroborative evidence to support the allegations. Staff and residents denied the claims, and observations did not reveal any violations. Therefore, the allegations were unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff smoking marijuana inside the facility and residents being unable to communicate with family members. Interviews with all staff and residents, as well as observations, did not support these allegations.
Report Facts
Capacity: 93
Census: 52
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| Mona Tirado | Administrator | Facility administrator interviewed during the investigation |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 93
Deficiencies: 0
Nov 2, 2020
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the licensee did not provide a resident's records to the authorized representative upon written request.
Findings
The investigation found no documentation proving that the resident had a power of attorney or authorized representative. Based on interviews and document review, there was insufficient evidence to substantiate the allegation, and the complaint was determined to be unsubstantiated.
Complaint Details
The complaint alleged that in May 2020, Resident #1's power of attorney requested resident records which were not provided. The investigation revealed no proof of a power of attorney or authorized representative in the resident's records, leading to an unsubstantiated finding.
Report Facts
Facility capacity: 93
Census: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jose Villalobos | Licensing Program Analyst | Conducted the complaint investigation |
| Mona Tirado | Administrator | Interviewed during investigation and exit interview |
| Fernando Fierros | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 93
Deficiencies: 1
Oct 19, 2020
Visit Reason
The inspection was an unannounced complaint investigation conducted due to a complaint received on 09/25/2020 regarding residents not being provided a copy of the admission agreement and other allegations.
Findings
The investigation substantiated the allegation that residents were not provided a copy of the admission agreement immediately upon signing, violating Title 22 regulations. Other allegations regarding inappropriate administrator intervention in resident council, facility disrepair, and nutrition were found unsubstantiated.
Complaint Details
The complaint was substantiated regarding residents not receiving admission agreements immediately upon signing. Other allegations about administrator intervention in resident council, facility disrepair, and nutrition were unsubstantiated. The investigation included telephonic interviews, virtual tours, and document reviews.
Deficiencies (1)
| Description |
|---|
| The licensee failed to provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative immediately upon signing. |
Report Facts
Capacity: 93
Census: 56
Plan of Correction Due Date: Oct 26, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tony Vasallo | Licensing Program Analyst | Conducted the complaint investigation |
| Wei Siew Ho | Licensing Program Manager | Oversaw the complaint investigation |
| Kimia Ateaiian | Administrator | Facility administrator involved in the investigation |
| Alba | Wellness Director | Interviewed during the investigation |
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