198320197-10-25-2024-11-AS-RORN-DENUJW-20250311153811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320197
Report Date: 10/25/2024
Date Signed: 10/25/2024 11:36:14 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2024 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240213144456

FACILITY NAME:	PLAZA AT WESTWOOD, THE		FACILITY NUMBER:	198320197
ADMINISTRATOR:	VIRGINIA ZENTENO		FACILITY TYPE:	740
ADDRESS:	2228 WESTWOOD BLVD		TELEPHONE:	(323) 217-7877
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	136	CENSUS:	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Theresa Pascual - Wellness Director		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1.Staff did not accept resident back into care following hospitalization.
2.Staff attempted to administer resident’s medication by force.

INVESTIGATION FINDINGS:

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

On 10/25/2024 the Department conducted a subsequent complaint visit to the facility to deliver findings for the allegations listed above. The Department was met by Luz Rose Executive Director, Administrator and the purpose of today’s visit was explained. The Department was granted access and allowed to enter the facility.

The investigation consisted of the following:
The department requested and received the following documents: Staff and Resident roster, SIR reports, physician's report, ALW appraisal, Summons for Eviction for residents, records from Southern California Hospital at Culver City, and other pertinent records associated with this complaint requested. A tour of the facility was conducted 02/27/2024. The department conducted interviews with witnesses #1 - witnesses #3 (W#1-#3), residents #1 - residents #8 (R#1-R#8) and staff #1 - staff #8 (S#1-S#8).

CONTINUE REPORT TO LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20240213144456

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 10/25/2024

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

Investigation Revealed the Following:

Allegations: Staff did not accept resident back into care following hospitalization.
On 02/22/2024 and 03/28/2024, the department interviewed Luz Rose, Administrator who was asked if staff did not accept resident back into care following hospitalization, and the Administrator stated there were no concerns or issues. Per the Administrator, Luz Rose, they had a resident that required a higher level of care. On 02/22/2024 and 03/28/2024, the department interviewed staff 2-staff 8 (S2-S8) regarding the allegation staff did not accept resident back into care following hospitalization, of those interviewed S2-S8 stated there were no concerns about resident being let back into the facility after hospitalization. On 02/22/2024 and 03/28/2024, the department interviewed witnesses #1 - witnesses #3 (W#1-#3). Of those interviewed W1-W3 stated there was an issue accepting resident back into facility after hospitalization. On 02/22/2024 and 03/28/2024, the department interviewed residents #1 - residents #8 (R#1-R#8). Of those interviewed 8 out of 8 stated they did know of anyone resident who has not been accepted back into the facility following hospitalization. The department attempted to interview R9, but they refused. On 02/22/2024, 03/28/2024 and 10/21/2024, the department conducted record reviews. Records show communication between facility, hospital, and a skilled nursing facility.

Based on interviews and observations there is insufficient evidence to support the allegation: Staff did not accept resident back into care following hospitalization. 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.

CONTINUE TO LIC9099C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20240213144456

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 10/25/2024

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

Allegation: Staff attempted to administer resident’s medication by force

On 02/22/2024 and 03/28/2024, the department interviewed Luz Rose, Administrator who was asked if staff attempted to administer resident’s medication by force, and the Administrator stated there were no concerns or issues. Per Luz Rose staff does not administer resident’s medication by force. On 02/22/2024 and 03/28/2024, the department interviewed staff 2-staff 8 (S2-S8) about staff attempting to administer resident’s medication by force, of those interviewed S2-S8 stated the staff does not administer resident’s medication by force. On 02/22/2024 and 03/28/2024, the department interviewed residents #1 - residents #8 (R#1-R#8). The department attempted to interview R9, but they refused. Of those interviewed 8 out of 8 stated they did know of any resident that had been administered medication by force.

Based on interviews and observations there is insufficient evidence to support the allegation: Staff attempted to administer resident’s medication by force. 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 with Luz Rose Executive Director and a copy of this report and appeals rights provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3