197606171-8-4-2020-28-AS-MVAO-BSELQV-20200812085806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606171
Report Date: 08/03/2020
Date Signed: 08/04/2020 02:18:49 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
04/30/2020 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200430115654

FACILITY NAME:	GOLDEN MANOR RETIREMENT CENTER		FACILITY NUMBER:	197606171
ADMINISTRATOR:	MARIA JACOBO		FACILITY TYPE:	740
ADDRESS:	1109 WEST BEVERLY BLVD.		TELEPHONE:	(323) 724-3870
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	160	CENSUS: 109	DATE:	08/03/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Assistant Administrator Carmen Virreta		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff is not keeping the facility at a comfortable temperature
Facility staff are not providing a good quality of food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted by tele-video with Assistant Administrator Carmen Virreta.
LPA Trueman on 8/3/2020 at 10:30 AM conducted a tour of the facility which included the kitchen and the food supply and resident rooms including air conditioning units in the hallways and the rooms.
At 11:AM Assistant Administrator Carmen Virreta was interviewed.
At 11:20 AM Office Supervisor Robert Blanco was interviewed.
At 11:30 to 12:15 Resident's 2-7 were interviewed. Resident 1 no longer resides at the facility.
In regards to the allegation Facility staff is not keeping the facility at a comfortable temperature, during tour of the facility LPA observed hallway air conditioners set at 73 F. and operating at cool.In tour conducted in Rooms 64, 67, 68 and 73 air conditioning units were set at 75 and cool.Resident 1's room 72 was toured now vacant and air conditioning was operable with air visibly blowing a paper over the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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-20200430115654

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: GOLDEN MANOR RETIREMENT CENTER	FACILITY NUMBER: 197606171
	VISIT DATE: 08/03/2020

NARRATIVE

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vent with air conditioning unit operable at 73 F.. and on cool.
In interviews conducted with staff they stated that there have been no complaints and all air conditioning units are operable.
Administrator stated that all rooms are set at 75 F. and some residents will open doors and windows and feel stuffy letting hot air in.
In interviews with residents they stated that all air conditioning units are operable and their rooms and the facility is comfortable temperature wise.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
In regards to the allegation Facility staff are not providing a good quality of food, LPA on tour of the kitchen along with Assistant Administrator Carmen Virreta observed a well balanced supply of 2 day perishable and 7 day non-perishables .
The foods included canned apple sauce, chocolate pudding, and fruit salad.
Meats included chicken, ground beef, bologna and ham.
There were vegetables, crackers, ice cream and watermelon.
Interviews with staff revealed that there is a well balanced supply of food and there are choices for residents who may like an option.
Interviews with residents revealed that food is good, there are choices and the food is of good quality.
Residents interviewed stated that they have never found anything harmful in their meals.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
A telephonic exit interview was conducted with Assistant Administrator Carmen Virreta , and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

LIC9099 (FAS) - (06/04)

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