191504447-8-27-2020-28-AS-MCAA-BUFT7V-20201016142918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191504447
Report Date: 08/27/2020
Date Signed: 08/27/2020 04:12:00 PM

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 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
06/08/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200608164113

FACILITY NAME:	SANTA ANITA RETIREMENT CENTER		FACILITY NUMBER:	191504447
ADMINISTRATOR:	NAFTALI BURSTEIN		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVE. #84		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	150	CENSUS: 78	DATE:	08/27/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Marco Villegas		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not give resident mail from her family members.
Staff are not allowing the resident to visit with her family.
Staff are not allowing the resident to visit with her friend.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez initiated a telephonic subsequent complaint investigation to deliver investigation findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Marco Villegas.

Investigation consisted of the following: During the initial telephonic visit conducted on 6/16/20, LPA Gonzalez conducted a telephone interview with Administrator Marco Villegas and requested copies of Staff and Resident Rosters. On 8/6/20, LPA Gonzalez conducted a telephone interview with Administrator Villegas and virtual Facetime interviews with Residents 2-5 (R2-5). LPA attempted to interview R1 but resident refused interview. LPA also conducted a virtual Facetime tour of facility which included a tour of facility office where mail is received and sorted prior to delivery to residents. LPA requested copies of documents pertaining to R1

(See LIC 9099C for continuation of report)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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 28-AS-20200608164113

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA ANITA RETIREMENT CENTER	FACILITY NUMBER: 191504447
	VISIT DATE: 08/27/2020

NARRATIVE

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and received documents via email from Administrator. On 8/7/20, LPA Gonzalez conducted telephone interviews with facility staff: Patient Care Supervisor Nancy Adams and Office Coordinator Arlette Rodriguez. On 8/7/20, LPA conducted an interview with R1's POA via telephone and received copies of documents pertaining to R1 via email from POA. On 8/11/20, LPA Gonzalez conducted a virtual Facetime interview with R1 and requested additional documents regarding R1 from Administrator. Documents were received via email.

The investigation revealed the following: In regard to allegations, Staff do not give resident mail from her family members, it is alleged mail is not delivered to R1. Interviews conducted with 5 out of 5 residents revealed that they do not have any issues regarding receiving their mail and are satisfied with the way delivery of mail is handled at the facility. R2-5 stated that mail is held at the office and they go to the desk to pick up their mail. R2-5 stated that if they have items that are large such as boxes the facility staff will bring it to their room. R1 stated that they do not have any complaints with not receiving their mail. R1 stated that when they have mail it is always brought to their room. Interviews with facility staff revealed that all residents get their mail on a daily basis if they received anything. Staff stated that mail is sorted out in the front office and held until residents come to the front office to pick up. Staff stated that there are some residents that staff deliver their mail to their room due to resident's medical conditions or per resident's requests. Staff stated that if residents have boxes or heavy items they will deliver to the resident's rooms. Based on interviews conducted with facility staff and residents and LPAs observations, there was not enough supportive evidence to concur with the reported allegation.

For the allegations, Staff are not allowing the resident to visit with her family and Staff are not allowing the resident to visit with her friend, it is alleged that facility is not allowing family or friends to visit with R1. Interview conducted Administrator Villegas revealed that the facility does allow residents to visit with family and friends. Administrator did clarify that since the beginning of the Coronavirus pandemic the facility did begin limiting entry only to individuals who need entry, as necessary for prevention, containment, and mitigation measures as specified by the Centers for Disease Control and Prevention (CDC), the California Department of Public Health (CDPH), and local health departments. Administrator stated that aside from that residents are never denied visits from anyone and stated that a resident will make the determination of accepting a visit or not. Interviews with facility staff revealed that residents are never denied visits and stated

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200608164113

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA ANITA RETIREMENT CENTER	FACILITY NUMBER: 191504447
	VISIT DATE: 08/27/2020

NARRATIVE

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that during the COVID-19 pandemic entry is limited to only medical personnel and government personnel. Facility staff stated that in lieu of in-person visits and social gatherings, the facility provides alternate means of communication for residents and their loved ones or other visitors by means such as phone calls, and video calls. Facility staff indicated that the facility has four (4) IPad tablets available for residents use. Interviews conducted with 5 out of 5 residents revealed that they have never had an issue or problems with getting visits from family and or friends. R1-5 stated that due to COVID-19 they are not able to receive visits at the moment and stated that although they do miss in person visits they know that it is the best thing to do to avoid getting sick. R1-5 stated that they are able to make phone calls and use the IPad tablets to make video calls with family and friends. Based on interviews conducted with facility staff and residents and LPAs observations, there was not enough supportive evidence to concur with the reported 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.

Exit interview held. A copy of the report was provided to Administrator Marco Villegas.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC9099 (FAS) - (06/04)

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