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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 06/19/2025
Date Signed: 06/19/2025 02:51:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/09/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250609145039
FACILITY NAME:TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THEFACILITY NUMBER:
198603383
ADMINISTRATOR:JAKINI, ROBERTFACILITY TYPE:
740
ADDRESS:1155 VIA VERDETELEPHONE:
(909) 293-6466
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:60CENSUS: 41DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Suby Kumar, Executive Director TIME COMPLETED:
02:53 PM
ALLEGATION(S):
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Staff left residents in wet diapers for extended periods of time
Staff did not ensure resident's showering needs were met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with the Executive Director, Suby Kumar and Mark Chisum, Environmental Services Director. The purpose of the visit was explained.

LPA toured the facility with staff Mark Chisum, including common areas and all the rooms on the second floor and five random rooms on the first floor, obtained copies of documents, and held interviews with eight (8) residents (R#1-R#8) and six (6) staff (S#1-S#6), and four (4) witnesses W#1-W#4
The investigation revealed the following:

Allegation: Staff left residents in wet diapers for extended periods of time. It is alleged that some residents are left in wet diapers for extended periods of time. LPA interviewed eight (8) residents, and all eight (8) residents were not able to corroborate the allegation.
(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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 2
Control Number 28-AS-20250609145039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 06/19/2025
NARRATIVE
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(continued from 9099)
LPA interviewed six (6) staff and three (3) of six (6) staff members denied the allegation. Three (3) staff members stated that occasionally they will discover resident in soaking wet diapers. One (1) staff member stated that is not very often and that it is just one resident who may be too heavy and burdensome to tend to. LPA interviewed four (4) witness, two (2) are family members and all four (4) witness stated that witnesses do not have any evidence of residents left in wet diapers. One (1) witness stated things have improved since witness verbally brought the issue to staff and stated that witness has no issues with the care at facility at this time. LPA did not observe any residents with bad odor and all the residents. LPA observed residents were clean and in clean clothes during the visit. LPA reviewed the May 2025 Electronic Charting Program (ECP) for three residents in question, and it showed that staff are making their rounds, and providing residents hygiene and bathing services and documenting it on the ECP. LPA observed the rooms to be very clean. LPA observed staff providing care and activities for residents during the visit. There is not sufficient evidence to substantiate this allegation.

Allegation: Staff did not ensure resident's showering needs were met. It is alleged that residents are not being showered as required. LPA interviewed eight (8) residents, and all eight (8) residents were not able to corroborate the allegations. LPA interviewed six (6) staff and five (5) of six (6) staff denied the allegations. All staff stated they provide showering for all residents unless they refuse. LPA interviewed four (4) witness and four (4) of four (4) were not able to corroborate the allegation. LPA reviewed the May 2025 Electronic Charting Program (ECP) for three residents in question, and it showed that staff are making their rounds, and providing residents hygiene and bathing services and documenting it on the ECP. LPA observed all residents to be clean and did not omit and body odor. Two (2) residents stated that they bathe themselves. LPA observed that the showers in most rooms inspected were recently used as there was current water residue left behind in the shower and adjacent floor that provided evidence that residents are being showered. There is not sufficient evidence to substantiate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Executive Director, Suby Kumar. A copy of this report, along with the appeal rights, was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2