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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320420
Report Date: 07/23/2025
Date Signed: 07/23/2025 12:48:54 PM

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
03/21/2025 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20250321122706
FACILITY NAME:HAYWORTH TERRACEFACILITY NUMBER:
198320420
ADMINISTRATOR:MIRAN BAEFACILITY TYPE:
740
ADDRESS:325 N HAYWORTH AVETELEPHONE:
(323) 655-3101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:111CENSUS: 46DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Terri HanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff can not effectively communicate with resident in care.
Facility staff do not provide resident with activities.
Facility staff are not assisting with soiled diapering in a timely manner.
The resident's grooming needs are not being met.
Facility staff did not maintain a comfortable temperature for residents.
INVESTIGATION FINDINGS:
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This report serves to clarify the investigation narrative and is created to supersede the LIC 9099 and LIC 9099C reports dated June 5, 2025. Although this report supersedes the previous report, the complaint investigation findings remain the same. On July 23, 2025, LPA conducted a subsequent complaint visit. LPA Richard met with Manager Miran Bae, Assistand Administrator Terri Han and explained the purpose of the visit. The investigation included the following steps: On March 27, 2025, Licensing Program Analyst (LPA) Antonine Richard conducted an initial unannounced complaint visit. The investigation involved interviews, the collection of records, and a tour of the facility. LPA Richard interviewed three staff members #1-3 (S1, S2, and S3), the Administrator (A1), Hien Hwang, and four residents #2-6 (R2 to R6). and attempted ot interviewe resident #1 (R1). Several documents were reviewed and obtained during the visit, including the Facility Staff Roster, Resident Roster, Identification and Emergency Information for Resident #1 (R1), Medical Consent Form, Appraisal/Needs and Service Plan, Personal Rights, Medication Administration Records, Physician's Report, scheduled activities, and appointments with the foot doctor, along with other relevant records related to the complaint.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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 6
Control Number 11-AS-20250321122706
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: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 07/23/2025
NARRATIVE
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Allegation #1: Facility staff cannot effectively communicate with residents in care.

The complaint alleges that the staff speak Korean, and the residents speak Japanese, which often results in the residents being left alone.

On March 27, 2025, LPA Richard interviewed Administrator Hien Hwang (A1), who denied the allegation. A1 stated that the caregiver does speak English and assists all residents with their daily needs.

Between 10:00 AM and 12:30 PM on the same day, LPA Richard interviewed four Residents, 2-5 (R2-R6). Four out of the four residents denied the allegation and indicated that they had no problems communicating with the staff, even though they primarily speak Korean.

Additionally, between 10:00 AM and 12:30 PM, LPA Richard interviewed three staff members #1-3 (S1-S3). All three staff members denied the allegation, asserting that everyone who works there speaks English and is fully capable of assisting the residents in their care. During the visit, LPA observed the staff communicating effectively in English with both LPA and the residents without any difficulty. On March 27, 2025 LPA observed R1 sitting in the activities room with other residents, laughing. Later, at 1:30 PM on March 27, 2025, LPA Richard attempted to interview Resident #1 (R1) with the assistance of an interpreter; however, R1 was unable to communicate due to R1 experiencing cognitive impairment.

Based on information gathered and interviews, LPA did not find sufficient evidence to support the allegation “Facility staff cannot effectively communicate with residents in care.” Therefore, the allegation is unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20250321122706
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: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 07/23/2025
NARRATIVE
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Allegation #2: Facility staff do not provide a resident with activities.

The complaint alleges that the resident was frequently left alone in her wheelchair at a table without any activities to engage in, such as reading a book or watching TV. On March 27, 2025, LPA Richard interviewed Administrator Hien Hwang (A1), who denied the allegation. A1 stated that all residents have a TV in their rooms, allowing them to watch any show in any language they choose. Additionally, there is a large screen TV in the activities room, and daily activities are scheduled for all residents to participate in if they wish. Between 10:00 AM and 12:30 PM on the same day, LPA Richard interviewed four Resident #2-6 (R2-R6). Four out of the four residents denied the allegations and expressed a preference for watching TV in their rooms. They also indicated that the facility provided them with daily activities. Additionally, between 10:00 AM and 12:30 PM, LPA Richard interviewed three Staff members, 1-3 (S1-S3). All three staff members denied the allegations and stated that the facility has seven days of activities scheduled for all residents.

On March 27, 2025, during a review of the activities schedule, LPA Richard confirmed that the facility offers activities every day from 9:00 AM to 3:00 PM. Furthermore, on the same day, LPA Richard observed R1 sitting in the activity room with other residents playing some kind of card games, coloring papers, while other residents were watching their favorite show on TV. Later, at 1:30 PM on March 27, 2025, LPA Richard attempted to interview Resident #1 (R1) with the assistance of an interpreter; however, R1 was unable to communicate due to R1 experiencing cognitive impairment. Based on the information gathered and interviews, LPA Richard did not find sufficient evidence to support the allegation that “facility staff do not provide residents with activities.” Therefore, the allegation is deemed unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20250321122706
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: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 07/23/2025
NARRATIVE
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Allegation #3: Facility staff are not helping residents with soiled diapering quickly enough.

This complaint claims that residents are often left in dirty diapers for long periods without being changed. On March 27, 2025, between 10:00 AM and 12:30 PM, LPA Richard interviewed four residents (R2-R6). All four residents denied the allegation and stated that they are changed every one to two hours each day. On the same day and during the same time, LPA observed R1 being cleaned, and the caregiver (S2) was checking to see if R1 needed a diaper change.

LPA Richard also interviewed three staff members (S1-S3), all of whom denied the allegation and reported that residents are changed every two hours or sooner if an accident occurs before or shortly after the scheduled change. The Administrator (A1) confirmed that residents are checked every one to two hours. A review of the changing schedule from February 1, 2025, to March 30, 2025, showed a list of residents who wear diapers along with their scheduled change times. Later, at 1:30 PM on March 27, 2025, LPA Richard attempted to interview Resident #1 (R1) with the help of an interpreter; however, R1 was unable to communicate due to experiencing cognitive impairment.

Based on the information gathered and interviews, LPA Richard did not find sufficient evidence to support the allegation that “facility staff are not assisting with soiled diapering in a timely manner.” Therefore, the allegation is deemed unsubstantiated

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20250321122706
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: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 07/23/2025
NARRATIVE
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Allegation #4: The resident’s grooming needs are not being met.

The complaint alleges that the resident’s toenails are often not trimmed. On March 27, 2025, between 10:00 AM and 12:30 PM, Licensing Program Analyst (LPA) Richard interviewed the Administrator, who denied the allegation. The Administrator stated that the facility has a podiatrist who visits every month to provide podiatry services to the residents. During the same period, LPA Richard interviewed four residents (R2 to R6). All four residents denied the allegation, stating that a pedicurist comes every month to assist them with their nails and toes. Additionally, on March 27, 2025, LPA Richard observed that Resident 1 (R1) had well-maintained feet and toenails and noted that R1 was included in the facility's monthly pedicurist schedule.

Additionally, LPA interviewed three staff members (S1-S3) on March 27, 2025, between 12:30 PM and 1:30 PM. They also denied the allegation and confirmed that a podiatrist visits the facility each month to service the residents' nails and toes.

Records reviewed by LPA, including the facility's foot doctor schedule dated February 13, 2025, indicated that residents receive podiatric services regularly. Furthermore, LPA observed that most residents' feet were well-trimmed and clean. Later, at 1:30 PM on March 27, 2025, LPA Richard attempted to interview Resident #1 (R1) with the help of an interpreter; however, R1 was unable to communicate due to R1 experiencing cognitive impairment.

Based on the information gathered and interviews, LPA Richard did not find sufficient evidence to support the allegation that the resident’s grooming needs were not being met. Therefore, the allegation is deemed unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20250321122706
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: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 07/23/2025
NARRATIVE
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Allegation #5: Facility staff did not maintain a comfortable temperature for residents.

The complaint alleges that the resident's room is covered with wallpaper, preventing proper heat flow, which keeps the resident's room cold. On March 27, 2025, between 10:00 AM and 12:30 PM, the Licensing Program Analyst (LPA) interviewed A1, who denied the allegations. A1 stated that each room is equipped with a heat control system that allows residents to adjust the temperature themselves.

During the same time frame, LPA Richard interviewed four residents (R2-R6), all of whom denied the allegations. They reported that their rooms were comfortable and that they could turn the heater on or off as needed. Additionally, on March 27, 2025, between 10:00 AM and 12:30 PM, LPA Richard interviewed three staff members (S1-S3), who also denied the allegations.

Additionally, the Licensing Program Analyst (LPA) visited the rooms of five residents and requested that the heaters be turned on during each visit. The rooms were not cold, and the heaters were functioning properly, providing warm air. During a tour of Room #1 (R1), the LPA noted that the room was warm. When the heater was turned on, it also worked correctly in R1’s room. At 1:30 PM on March 27, 2025, LPA Richard attempted to interview Resident #1 (R1) with the assistance of an interpreter; however, R1 was unable to communicate due to cognitive impairment.

Based on the information gathered and interviews, LPA Richard did not find sufficient evidence to support the allegation that the resident’s grooming needs were not being met. Therefore, the allegation is deemed unsubstantiated.

No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Assistant Administrator Terri Han.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6