<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607476
Report Date: 09/10/2020
Date Signed: 09/10/2020 03:25:39 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 Elizabeth Irra
COMPLAINT CONTROL NUMBER: 28-AS-20200608161226
FACILITY NAME:VISTA COVE AT ARCADIAFACILITY NUMBER:
197607476
ADMINISTRATOR:NOEMI BIELYFACILITY TYPE:
740
ADDRESS:601 SUNSET BOULEVARDTELEPHONE:
(626) 447-0106
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:130CENSUS: 60DATE:
09/10/2020
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Noemi BielyTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra 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 telephonically with Noemi Biely (Facility Administrator).

The initial investigation was conducted on 06/16/2020. On 06/16/20 at approximately 1:50 P.M, LPA Irra conducted a telephone interview with the Facility Administrator and Staff #1 (S-1). LPA requested copies of the following to be submitted to LPA via email by 06/16/20: Staff Roster (including a list and contact phone numbers for staff that are aware of this situation), Resident Roster and Policy on Safeguarding Residents belongings. LPA requested the following for Resident #1 (R-1): Admission Agreement, current Physician Report, Appraisal Needs & Services Plan, Emergency Contact sheet, Power of Attorney (POA) documentation, copies/reference/case number for all parties involved APS, LTCO and Police Department and any notes relevant to the allegation noted above.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
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-20200608161226
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: VISTA COVE AT ARCADIA
FACILITY NUMBER: 197607476
VISIT DATE: 09/10/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff failed to safeguard resident's personal belongings.
During this investigation, LPA interviewed the Facility Administrator and Staff #1 (S-1). LPA also interviewed R-1, Alleged Perpetrator and requested a copy of the Police Report. LPA also contacted LTCO and APS to obtain status. Interviews revealed that R-1 handles R-1's own checkbook and personal cell phone. Interviews revealed that there has not been any concerns from R-1 pertaining to her personal belongings other than this incident. Interviews revealed that the alleged perpetrator returned R-1's checkbook and cell phone and has not had any contact with R-1. R-1 indicated R-1 will not be relocated to another facility. Interviews revealed that staff from this facility assisted R-1 in obtaining a new checking account and new cell phone and have been assisting R-1 on paying R-1's bills every other week. Additionally, interviews revealed R-1 has hired legal services to handle R-1's fiduciary services. R-1 was unable to further elaborate. Interviews conducted do not corroborate 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.

A telephonic exit interview was conducted with the Facility Administrator, a hard copy was provided via email for signature and Appeal Rights were provided.


SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2