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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320127
Report Date: 11/16/2021
Date Signed: 11/16/2021 02:51:47 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
10/11/2021 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211011130958
FACILITY NAME:WATERMARK AT WESTWOOD VILLAGE, THEFACILITY NUMBER:
198320127
ADMINISTRATOR:MURPHY, PATRICIAFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:237CENSUS: 28DATE:
11/16/2021
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Nicolle Hoznor, Resident’s Care Services Director / LVNTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Unqualified staff is administering medications to residents
Resident's belongings are not being safeguarded while in care
INVESTIGATION FINDINGS:
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On 10/20/2021 Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the following allegations. LPA Agard was met with Nicolle Hoznor, Resident’s Care Services Director / LVN and explained the purpose of the visit was to gather information regarding this complaint.

The investigation consisted of the following: LPA Agard toured the facility, conducted interviews with staff, residents, and reviewed records.

On 11/16/2021 LPA Agard delivered findings.

Regarding the allegation: unqualified staff is administering medications to residents. It’s being alleged that a caregiver is giving medication without training. The investigation revealed the following: 9 out of 9 staff

Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20211011130958
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: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 11/16/2021
NARRATIVE
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interviewed denied the allegation to be true. S2-6 either state the allegation is false, not true or they have been properly trained. S8 and S9 state they have never been asked to give medication in their role as caregivers.

During interviews with residents, the investigation revealed the following. 4 out of 6 are enrolled in the medication administration program. Of the 4, they all denied the allegation to be true. R1 acknowledges the medication error but states there were no adverse effects. R2-4 all state not having their medication administered by an unqualified individual.

Regarding the allegation: Resident's belongings are not being safeguarded while in care. It’s being alleged a resident is saying that people are taking their things. The investigation revealed the following: 9 out of 9 staff interviewed denied the allegation to be true. 9 out of 9 state the resident’s items are safely stored and safeguarded or that a resident has never made such claims. S6 states the facility discourages the families from leaving anything of value at the facility. S6 also states, in supporting residents with memory care needs, it isn’t unusual for them to allege something is missing.

During interviews with residents, the investigation revealed the following. 6 out of 6 residents state their belongings are safeguarded while in care. R1-6 either state not having any issues with their belongings going missing or they have an additional safe for valuable items.



During a record review, LPA verified all initials on Medication Administration Record (MAR) and found all initials to be of the Medication Technician (Med Tech). LPA also reviewed and verified trainings completed for Med Tech’s. Training include classroom training from a licensed professional, followed by shadowing and examinations. During a file review of admissions agreement, facility does not have a surety bond. Residents are discouraged from bringing items of high value to the facility. Per resident’s admissions agreement, the facility denies liability of a resident’s personal belongings. Which includes but is not limited to theft unless it is delivered to Watermark for safeguarding.

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(s) 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: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2