198205367-9-6-2022-11-AS-UCOL-CK4N6C-20221011101056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205367
Report Date: 09/06/2022
Date Signed: 09/06/2022 02:09:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220902131031

FACILITY NAME:	WESTCHESTER VILLA		FACILITY NUMBER:	198205367
ADMINISTRATOR:	EVANGELINE AGATEP		FACILITY TYPE:	740
ADDRESS:	220 W. MANCHESTER BLVD.		TELEPHONE:	(310) 673-1093
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90301
CAPACITY:	174	CENSUS: 87	DATE:	09/06/2022
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Evangeline Agatep		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to provide a comfortable temperature for residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/06/2022, Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation to address the allegation listed above. LPA Agard met with Evangeline Agatep, Administrator and explained the purpose of this visit is to gather information for the complaint and deliver findings.

The investigation consisted of the following: LPA Agard conducted a tour of the facility grounds. The facility is a two-story commercial building. The floor plan contains a lobby/receptionist area, business office, medication room, administrator's office. There are 87 bedrooms and bathrooms, storage rooms, 3 living rooms, 2 dining rooms, kitchen, commercial laundry room, recreational space, restrooms located in the common area, 2 employee lounges, beauty salon, linen room, housekeeping supply room, patios, shaded area, indoor/outdoor activity area, and a gated security parking lot. LPA interviewed staff, residents, and reviewed records. LPA Agard requested the following documents, which were received at the time of visit: 1) a copy of the staff roster, 2) a copy of the resident roster.
Cont, on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20220902131031

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WESTCHESTER VILLA	FACILITY NUMBER: 198205367
	VISIT DATE: 09/06/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 09/09/2022, LPA delivered findings.

The investigation revealed the following: Regarding the allegation: Facility failed to provide a comfortable temperature for residents in care. “It’s being alleged that it’s extremely hot inside the facility and the facility doesn’t turn on the AC.” On 09/06/2022, LPA interviewed 8 out of 29 staff in total. 6 out of 8 denied the allegation to be true. S1 states, “the air is on as you can feel it. We usually keep the temp at 78. At 11am we start to adjust the temp to 74 and try to check the windows and sliding doors.” S2 states, “no, it’s quite the opposite. Sometimes we turn the air down for the staff but most of the residents get cold easily. We have that issue. We have to constantly adjust. We keep it at 76 to 78 and that’s usually enough to take the humidity out.” S4 states, “right now, the temperature in the hallway is okay for me.” S6 states, “well, over the weekend it was really hot because of the heat weave and we’ve had the AC on even before the heat wave started. Sometimes we have to check the residents sliding doors but a lot of them are keeping them open and that’s what contributes to the building being warm. Right here where I work the temperature is comfortable. We have visitors sit here and no one really complains. The thermostat is adjusted because we make sure it’s between 76 to 78 degrees. They adjust it in the morning to make sure it’s good throughout the day.”

During interviews with residents, LPA interviewed 8 out of 87 residents. 5 out of 8 denied the allegation to be true. R2 states, “I’m fine it’s not that warm. I can’t complain. I’m not sure if other people are complaining.” R3 states, “I don’t think so, we get colder faster, so I always have to put on layers. It’s okay.” R5 states, only because of the heat outside. You will still see people in the dining room today with jackets and coats on. It depends on your age and how you like it. We have never been denied air. They will swear up and down that there is no air conditioning. So why are folks wearing jackets and coats? Look around.” R8 states, “the temperature is alright, it doesn’t even get warm. It feels good.”

During a record review, LPA reviewed the following records: a staff roster not dated. All staff interviewed matches with roster. A resident roster dated September 2022. All residents interviewed matches with the roster. LPA observed the facility temperature to be warm. When LPA checked the thermostat, LPA observed the thermostat set at 80 degrees. LPA observed two of the five thermostats set to fan mode which meant the AC was not cooling that area. LPA observed Administrator change thermostat settings to ensure cool air was blowing. LPA observed the usage of fans by staff and residents. LPA observed the memory care unit and

cont on 9099C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20220902131031

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WESTCHESTER VILLA	FACILITY NUMBER: 198205367
	VISIT DATE: 09/06/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

some parts of the building to be significantly cooler than others. Based on title 22 regulation 87303, the facility temperature was observed within range.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3