197607476-9-4-2020-28-AS-FFIS-BTAVD7-20200909162013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607476
Report Date: 09/01/2020
Date Signed: 09/04/2020 09:17:15 AM

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
08/26/2020 and conducted by Evaluator Shawna Day

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200826114059

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:	130	CENSUS: 64	DATE:	09/01/2020
		UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Noemi Biely		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Drinking water was not available to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Day conducted the “Initial investigation visit to ascertain information pertaining to the above-mentioned allegations and to establish the validity of the complaint.
Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically and with facetime.
This is a Elderly facility with three (3) separate floors.
During this visit LPA facetime the Administrator and observed the following: On the 1st floor LPA observed three (3) watercoolers with water located in the facility lobby, the activity room and the wellness room. All accessible to the residents.
On the 2nd floor, LPA observed two (2) water coolers with water at each end of the lobbies, both accessible to the residents.
On the 3rd floor, LPA observed one (1) watercooler with water in the middle of the lobby accessible to the residents.
LPA interviewed staff and residents who were consistent with their statements that there is always available water for the residents throughout the facility. There is water served with every meal and water is on each

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Shawna Day	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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-20200826114059

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: 09/01/2020

NARRATIVE

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floor and in the kitchen. Residents informed LPA that they have never known the facility to run out of water. Administrator provided LPA with current invoices from Ready Refresh Water Company where they purchase 24 gallons of water every 2 months. The LPA finds that there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

A telephonic exit interview was conducted with Administrator and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Shawna Day	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

LIC9099 (FAS) - (06/04)

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