191504447-10-9-2023-28-AS-RORN-CWQNQ5-20231018103921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191504447
Report Date: 10/09/2023
Date Signed: 10/09/2023 02:23:22 PM

Unsubstantiated

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
12/07/2021 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211207143136

FACILITY NAME:	SANTA ANITA RETIREMENT CENTER		FACILITY NUMBER:	191504447
ADMINISTRATOR:	GEMMA DEOSO		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVE. #84		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	0	CENSUS: 125	DATE:	10/09/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maya Mnoyan		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff administered resident a medication not prescribed by her physician
Staff are not refilling resident's medication in a timely manner
Resident's toilet is in disrepair
Staff did not prevent inappropriate interactions between resident's

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Maya Mnoyan who assisted with today's visit.

The investigation consisted of interviews with Staff #1 - Staff #5, and Resident #1 - Resident #11, as well as review of Resident #1's file, and medication. LPA Rea conducted an initial visit on12/13/21.

Regarding the allegation that Staff administered resident #1 a medication not prescribed by her physician, Staff interviewed denied the allegation. Staff interviewed stated that resident #1 was prescribed a medication after being seen by a nurse practioner. Staff stated that resident #1 refused the medication and it was discontinued. Residents interviewed were unable to corroborate the allegation. Ten out of eleven residents stated that staff ony administer medication that has been prescribed by their physician.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

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-20211207143136

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: 10/09/2023

NARRATIVE

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Regarding the allegation that staff are not refilling resident's medication in a timely manner. Staff interviewed denied the allegation. Staff stated that the facility ensures that resident's medication is ordered from the pharmacy in a timely manner. Staff stated that in October 2021, resident #1's physician sent a prescription order to the wrong pharmacy. However, the facility ensured that resident #1 received the medication that was prescribed, and the prescription order was corrected and sent to the correct pharmacy. LPA observed on initial visit, and on today's visit, that resident #1's medication appears to be administered as prescribed. Residents interviewed were unable to corroborate the allegation. Eight out of eleven residents interviewed stated that they are receiving their medication in a timely manner.

Regarding the allegation that Resident #1's toilet is in disrepair, Staff interviewed denied the allegation. LPA toured facility on initial visit, and on today's visit, and observed that toilets are operational. Staff stated that if anything is in disrepair, they put it in the maintenance log, and the maintenance person will repair it in a timely manner. Residents interviewed were unable to corroborate the allegation. Ten out of eleven residents interviewed stated that the facility toilets are not in disrepair.

Regarding the allegation that staff did not prevent inappropriate interactions between resident's. Staff interviewed denied the allegation. They stated that staff always try to resolve altercations between residents, when they observe them. Residents interviewed were unable to corroborate the allegation. Ten out of eleven residents interviewed stated that staff do intervene and assist in resolving altercations between residents.

Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC9099 (FAS) - (06/04)

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