197608888-2-10-2026-11-AS-SCIS-DUUW3S-20260608165617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 02/10/2026
Date Signed: 02/10/2026 03:33:56 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
10/02/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251002104817

FACILITY NAME:	WEST PICO TERRACE ASSISTED LIVING CENTER LP		FACILITY NUMBER:	197608888
ADMINISTRATOR:	CHRISTOPHER,MELISSA		FACILITY TYPE:	740
ADDRESS:	6050 W PICO BLVD		TELEPHONE:	(323) 653-5565
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	136	CENSUS: 90	DATE:	02/10/2026
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Azucena Reyes		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff are not properly supervising resident who is a fall risk.

INVESTIGATION FINDINGS:

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On 02/10/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint investigation visit to investigate the above-mentioned allegation and deliver findings. LPA met with Administrator Azucena Reyes, explained the purpose of the visit, and was granted entry into the facility.

The investigation consisted of the following: On 10/08/25, LPA Gonzalez requested and obtained the staff roster and resident roster. LPA Gonzalez reviewed service records for resident #1 (R1) and requested copies of the following documents: Admission Record, Physician’s Report, Service Plan Report, Unusual Incident/Injury Reports, Medication Administration Record (MAR) for September 2025, Senior Living Assessment, medical records from Cedars-Sinai, and the In-Service/Staff Meeting Training Log. LPA Gonzalez conducted interviews with staff #1–#4 (S1–S4) and residents #2–#8 (R2–R8) and attempted to interview R1.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251002104817

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: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 02/10/2026

NARRATIVE

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On 01/06/26, LPA Gonzalez received additional documentation from Administrator Azucena Reyes, including the Service Plan Report and medical records from East Los Angeles Doctors Hospital for R1 (dated 10/08/25). On 02/10/26, LPA Gonzalez attempted to conduct an interview with R1. Additionally, LPA Gonzalez obtained a copy of R1’s Death Report.

The investigation revealed the following:
For the allegation: Facility staff are not properly supervising a resident who is a fall risk. It is alleged that the resident experienced multiple un-witnessed falls, resulting in injuries. On 10/08/25, LPA Gonzalez interviewed S1–S4. Of those interviewed, 4 out of 4 staff denied the allegation. 4 out of 4 staff said they have been trained in fall risk management. All staff stated that R1 does not have a one-on-one caregiver assigned, and that residents are checked every 2–3 hours and as needed. During the interview, S1 stated that R1 has resided at the facility for an extended period of time and is familiar with the layout of the facility. S1 reported that R1 frequently wanders throughout the facility and the adjacent Skilled Nursing Facility (SNF). S1 stated that caregivers are available 24 hours a day, 7 days a week, but no residents at the facility are assigned a one-on-one caregiver.

On 10/08/25, LPA Gonzalez conducted interviews with residents R2–R8. On 02/10/26, LPA Gonzalez attempted to conduct an interview with resident R1 but was unable to as LPA was informed that R1 had passed away on 10/31/26. Of those interviewed, 7 out of 7 residents stated that staff check on them frequently. 7 out of 7 residents stated that staff provide the necessary care and supervision required.

On 10/08/25, LPA Gonzalez conducted a review of records. The records reviewed included R1’s Physician’s Report dated 05/23/25, which documents that R1 is non-ambulatory and unable to leave the facility unassisted. A review of R1’s Service Plan Report dated 07/12/24 documents that R1 is not to leave the community unattended and that staff are to monitor R1’s whereabouts every two to three hours due to wandering behaviors. A review of an Unusual Incident/Injury Report dated 09/17/25 documents that R1 sustained an un-witnessed fall on 09/17/25. The report indicates that 911 was called and R1 was transported to Cedars-Sinai Hospital. Unusual Incident/Injury Report dated 10/01/25 documents that R1 sustained an un-witnessed fall on 09/29/25.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251002104817

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: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 02/10/2026

NARRATIVE

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According to the report, paramedics did not respond on 09/30/25. On 10/01/25, R1 was transported to East Los Angeles Hospital. A review of medical records from East Los Angeles Hospital dated 10/08/25 documents that R1 was admitted on 10/01/25 for generalized weakness and an un-witnessed fall. The records further indicate that R1 was discharged on 10/08/25 with orders to continue medications, monitoring, and placement in a skilled nursing facility (SNF). On 02/10/26, LPA Gonzalez conducted a review of R1’s Death Report (dated: 11/07/25), and it revealed that R1 passed away on 10/31/25.

Based on observation, records reviewed, and interviews conducted, there is insufficient evidence to support the allegation. 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.

No deficiencies were cited during this investigation.

An exit interview was conducted, and a copy of the report was provided to Azucena Reyes.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026

LIC9099 (FAS) - (06/04)

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