Inspection Reports for
Whittier Glen Assisted Living

The complaint was substantiated based on interviews with five residents and one staff member who confirmed rough handling by a staff member.

The investigation found that five residents and one staff member corroborated the allegation that a staff member handled residents roughly, resulting in a cited deficiency related to residents' personal rights and dignity.

The complaint investigation was triggered by allegations received on 2025-07-28 concerning staff delays in assisting a resident who sustained a fracture, failure to seek timely medical attention, staff yelling at residents, and insufficient staffing. The investigation included interviews with residents and staff, review of incident reports, hospital discharge paperwork, x-rays, and medication records. The allegations about assistance delays, medical attention, and yelling were unsubstantiated, while insufficient staffing was substantiated.

The investigation found the allegations that staff did not assist a resident in a timely manner resulting in a fracture, staff did not seek timely medical attention, and staff yelling at residents were unsubstantiated due to lack of corroborating evidence. However, the allegation of insufficient staffing was substantiated based on resident interviews indicating delays in assistance, posing a potential health and safety concern.

The complaint investigation was substantiated for the allegation that staff did not ensure the facility elevator was maintained in good repair. The elevator was out of service from 10/13/2025 to 10/31/2025, confirmed by staff and residents. The allegation regarding food quality and quantity was unsubstantiated.

The elevator was found to have been out of service from 10/13/2025 to 10/31/2025, substantiating the allegation that staff did not ensure the elevator was maintained in good repair. The allegation regarding food quality and quantity was unsubstantiated based on staff and resident interviews and observations.

Complaint-related visit triggered by an allegation addressed on 9099; deficiency substantiated with citation issued.

The Licensing Program Analyst observed that the medical assessment form LIC602A for resident R1 dated 08/29/2025 did not clearly indicate if the resident could administer their own injections and test glucose levels, as it was marked N/A under Medication Management sections b. and c. A deficiency was cited and a citation issued.

The complaint investigation was substantiated for allegations that staff did not ensure medications were dispensed as prescribed and properly managed. The allegation that call buttons were not answered timely was supported by findings of insufficient staffing. Other allegations regarding laundry, soiled clothing, malodors, floor cleanliness, and privacy of phone conversations were unsubstantiated.

The investigation substantiated that staff did not ensure medications were dispensed as prescribed and medications were not properly managed, posing immediate health and safety risks. It was also found that staffing levels were insufficient to assist residents timely. Other allegations related to laundry, soiled clothing, facility odors, floor cleanliness, and privacy of phone conversations were unsubstantiated.

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.

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.

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.

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.

The visit was complaint-related, triggered by a Serious Incident Report regarding the passing of Client #1. The report does not state substantiation status.

The Licensing Program Analyst found that the facility lacked a pre-admission or recent appraisal for Client #1, which poses a potential health and safety risk. The report documents the incident involving Client #1's choking and subsequent death despite emergency interventions.

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.

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.

The complaint investigation was initiated due to allegations including residents drinking alcohol on premises, failure to assist residents in obtaining medical care, facility malodor and dirtiness, failure to dispense medications as prescribed, failure to notify responsible parties of missed medical appointments, failure to meet dietary needs, and failure to meet showering needs. The alcohol consumption allegation was substantiated; all others were unsubstantiated.

The investigation substantiated the allegation that residents were drinking alcohol on the premises in violation of house rules, posing a potential health and safety risk. All other allegations including failure to assist residents in obtaining medical care, facility cleanliness, medication dispensing, notification of responsible parties, dietary needs, and showering assistance were found to be unsubstantiated based on interviews, observations, and record reviews.

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.

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.

The complaint alleged that staff did not accept Resident #1 back into care following hospitalization. The allegation was substantiated after investigation, finding that the facility refused to accept Resident #1 back after discharge on 05/15/2024 and did not provide the required 30-day eviction notice.

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.

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.

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.

The complaint investigation was triggered by allegations that staff did not ensure residents received their medications as necessary and did not assist a resident with glucose testing. The investigation found these allegations substantiated based on interviews, record reviews, and observations. Other allegations about food sufficiency, bathing assistance, and inappropriate comments were unsubstantiated.

The investigation substantiated that the facility failed to provide timely insulin and glucose meter to a resident, resulting in 25 days without medication and glucose testing, posing a potential health risk. Other allegations regarding insufficient food, bathing needs, and inappropriate staff comments were found to be unsubstantiated due to lack of evidence.

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.

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.

The complaint investigation was substantiated for failure to log and report incidents properly. Other allegations including staff neglect causing falls, unmet resident needs, leaving residents in soiled diapers, unmet showering needs, and insecure rent payment methods were unsubstantiated.

The investigation found that most allegations including falls due to sidewalk cracks, unmet resident needs, residents left in soiled diapers, unmet showering needs, and insecure rent payment methods were unsubstantiated based on interviews, observations, and file reviews. However, the allegation that staff were not properly logging incidents with residents was substantiated due to failure to report certain incidents to licensing as required.

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.

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.

Investigation was conducted for a complaint dated 3/18/22 regarding Resident #1 sustaining several documented falls in March 2022, including a fall causing a head laceration and hospitalization. The facility failed to update the service plan to reflect the resident's fall risk and change in condition.

The facility failed to update Resident #1's service plan to reflect changes in condition and fall risk, resulting in additional falls and a head laceration requiring hospitalization. Deficiencies were cited for not updating the pre-admission appraisal and plan of care as required by regulations.

The complaint investigation was substantiated for the allegation that staff left a resident in soiled diapers for an extended period of time. 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.

The investigation found that most allegations were unsubstantiated based on staff and resident interviews, file reviews, and observations. However, the allegation that staff left a resident in soiled diapers for an extended period was substantiated, with evidence showing failure to change the resident's diaper timely, resulting in rashes.

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.

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.

The complaint investigation was substantiated only for the allegation that the facility lacked a full-time Activity Director between March 2022 and July 2022. Other allegations including staff leaving a resident unsupervised after a fall, inadequate staffing, unqualified staff, and medication mismanagement were unsubstantiated.

The investigation found that most allegations including staff leaving a resident unsupervised after a fall, inadequate staffing, unqualified staff, and medication mismanagement were unsubstantiated due to lack of preponderance of evidence. However, the allegation that the facility did not have a full-time Activity Director for about four months was substantiated, constituting a regulatory deficiency.

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.

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.

The inspection covered 3 of 12 CARE tool domains including planned activities, disaster preparedness, and residents with special health needs. Deficiencies were cited related to incomplete hospice care plans for residents #1-#3, lacking evidence of licensee/staff involvement, posing potential health, safety, or personal rights risks.

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.

The visit was complaint-related, and the deficiency was substantiated as the equipment was found not operable during the investigation.

The Licensing Program Analyst found that three ovens and the overhead vent in the kitchen were not operable, posing a health and safety risk to residents. A deficiency was cited under Title 22, Division 6, Chapter 8, Article 10, Food Services.

The complaint investigation was substantiated. Allegations included facility smelling of urine and staff serving cold meals. Interviews with staff and residents confirmed these issues.

The investigation substantiated that the facility common areas had a persistent urine odor due to some residents refusing showers or diaper changes, and that meals were often served cold because hot food was placed on cold plates and the facility lacked adequate equipment to keep food warm.

The complaint was substantiated. The allegation was that staff served residents cold meals. Interviews with six staff and nine residents supported that food was served cold most of the time, though not undercooked. Several staff noted kitchen ovens were in disrepair and no dish warmer was available.

The investigation found the allegation substantiated based on interviews with staff and residents and observations. Residents reported meals were often served cold due to cold plates absorbing heat, and some kitchen ovens were in disrepair. The facility does not own a dish warmer to keep food hot.

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.

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.

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.

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.

The visit was complaint-related, and the deficiency was substantiated as the equipment was found not operable, posing a health and safety risk.

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.

The complaint involved 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 investigation found these allegations unsubstantiated except for the allegation of staff not properly supervising a resident, which was substantiated due to failure to verify Resident #2's capacity to consent to sexual encounters with Resident #3.

The investigation found the allegations of a resident sustaining a bruise, inappropriate touching of residents, and unsanitary conditions to be unsubstantiated except for the allegation of lack of proper supervision related to sexual encounters between residents, which was substantiated due to failure to verify consent capacity.

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.

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.

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.

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.

The complaint investigation was triggered by allegations of staff verbally abusing a resident (R11) by screaming and telling the resident to 'Shut up', failure to treat residents with dignity and respect, and failure to meet a resident's medical needs. The verbal abuse allegation was substantiated with evidence including a voice recording and termination of the staff member (S1). The medical needs allegation was unsubstantiated due to lack of sufficient evidence.

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 of failure to meet a resident's medical needs was unsubstantiated due to insufficient evidence.