197607476-1-10-2023-28-AS-RORN-CMZQTY-20230112112756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607476
Report Date: 12/12/2022
Date Signed: 01/10/2023 11:42:14 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
08/18/2020 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200818150007

FACILITY NAME:	VISTA COVE AT ARCADIA		FACILITY NUMBER:	197607476
ADMINISTRATOR:	NOEMI BIELY		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BOULEVARD		TELEPHONE:	(626) 447-0106
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	0	CENSUS: 0	DATE:	12/12/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jennifer Lan		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is in disrepair
Facility is malodorous
Facility is infested with insects
Facility staff failed to provide a safe and comfortable environment for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analsyt (LPA) Bennette Pena conducted an unannounced subsequent visit to Arcadia Living (new facility) and met with the Administrator, Jennifer Lan and discussed the purpose of today's visit.

During the initial visit telephonically conducted by LPA Bonnie Tao on 8/27/2020, investigation consisted of telephone interviews with Staff #1, Staff #4, Staff #8, Resident #1 and Resident #2. LPA obtained copies of LIC 500 and resident roster. LPA also requested the Administrator to provide a copy of pest control work order, invoice of August 2020 and a copy of plumbing issue/repairing contract. During the subsequent visit conducted by LPA Pena on 11/14/2022, investigation consisted of the following: obtained Staff/Resident roster and interviewed Resident #1-Resident #5 (R1-5) and Staff #1 (S1).

During today's visit, LPA Pena interviewed Staff #2-5 (S2-5). Former employees who are suitable for interviews are no longer working under the new ownership and no contact information available.
The facility is under a new change of ownership and was closed as of 02/17/2021; therefore, LPA Pena will mail findings to (former) Licensee.
*****REPORT CONTINUED ON LIC 9099-C******

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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-20200818150007

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA COVE AT ARCADIA	FACILITY NUMBER: 197607476
	VISIT DATE: 12/12/2022

NARRATIVE

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Regarding allegation: Facility is in disrepair . It is alleged that the facility has been working on a plumbing issue underground. The construction workers made 4 big holes in the kitchen area and one big hole in the dining area. The facility put a piece of wood on each hole and plastic to cover it, but the plastic has holes in it. Because of the hole the facility has a strong odor and mosquitoes are coming out of the holes plus it’s dangerous. Interviews conducted with (5) staff revealed that the dining room was under repair due to plumbing issues but can not remember when the work started. All staff confirmed that the work area was covered with a plastic material and there are no other areas in the facility that was being repaired at that time. S7 stated that the plumbing issue was between the kitchen and activity room.They all stated that there was no bad smell or foul odor and did not see any insect in the dining room. S1-5 could not remember seeing holes on the floor or on the wall. R1-R5 denied the allegation and stated that the facility was not in disrepair. R1-R5 stated there are a lot of things needed to be fixed but the staff worked on it. Based on statements and interviews conducted with residents and former staff, there was not enough supportive evidence to corroborate the allegation.

Regarding allegation: Facility is malodorous. It was alleged that the facility has been working on a plumbing issue underground and the construction workers made 4 big holes in the kitchen area and one big hole in the dining area. The RP stated that because of the hole, the facility has a strong odor. Interviews conducted with (4) out of (5) staff revealed that they did not smell any bad or suspicious odors. S5 stated that the facility was not smelly and the only time he smelled something was when they did the construction, but it was not bad at all. All 5 staff stated that the facility was not malodorous and staff clean the facility regularly. Common areas and residents rooms are cleaned daily and/or as needed. They would have reported any unpleasant odor if they smelled it because it could have caused or would have threatened the safety of the residents. Interviews with R1-5 revealed that they did not smell anything bad, even during the construction. Based on statements and interviews conducted with residents and former staff, there was not enough supportive evidence to corroborate the 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.

********REPORT CONTINUED ON LIC9099-C******

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200818150007

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA COVE AT ARCADIA	FACILITY NUMBER: 197607476
	VISIT DATE: 12/12/2022

NARRATIVE

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Regarding allegation: Facility is infested with insects. It is alleged that the facility has been working on a plumbing issue underground. The construction workers made 4 big holes in the kitchen area and one big hole in the dining area. Because of the hole the facility has a strong odor and mosquitoes are coming out of the holes. S1-4 stated that they did not see bugs or insects during the construction. S5 stated that during construction work, he saw insects but the exterminator was called and helped get rid of the insects. (5) out of (5) staff did not notice any insects or bugs in the facility that may have caused danger or have provided an unsafe environment for the residents. All (5) staff indicated that the facility was being serviced by exterminator for maintenance management and for bug prevention. Staff ensure that the facility is clean and sanitary for the residents safety and well-being. R1-5 denied the allegation and stated that they see few insects once in a while but nothing to be concerned about. (5) out of (5) residents stated that the facility staff are good with cleaning and keeping the place tidy. Based on statements and interviews conducted with residents and former staff, there was not enough supportive evidence to corroborate the allegation.

Regarding allegation: Facility staff failed to provide a safe and comfortable environment for the residents. Interviews conducted with (5) staff revealed that the facility conducted numerous in-service training annually to ensure a safe and comfortable environment for the residents. S1-5 denied the allegation and indicated that the training they received were useful for them to provide safe and comfortable environment for the residents every time. (5) staff indicated that the facility had enough staff per shift to cover the needs of the residents. S2-3 stated that they did not smell any foul odor nor have seen insects or bugs in the facility. S2-3 and other staff regularly disinfected the dining room to make sure it was a safe area for the residents. S7 indicated that she conducted council meeting to communicate residents needs. S1-5 stated that they were not aware of any complaints about this incident from residents. Interviews with all (5) residents revealed that they feel safe and comfortable in the facility. Staff helped them all the time whenever they needed assistance. All (5) residents cannot recall when the plumbing issue started, but stated that they did not have any complaints during the time the facility had plumbing issues.
Based on statements and interviews conducted with residents and former staff, there was not enough supportive evidence to corroborate the 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 copy of this report and Appeals Rights will be mailed to the former Licensee as the facility was closed as of 02/17/2021.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

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