197607476-5-4-2021-28-AS-MVAO-C2QQGD-20210505120920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607476
Report Date: 05/03/2021
Date Signed: 05/04/2021 03:26:42 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
09/02/2020 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200902172202

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:	DATE:	05/03/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Miles Yoshisato		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's medication.
Staff did not administer medication to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the initial complaint investigation was conducted on 09/09/20 telephonically with Noemi Biely (Facility Administrator).

During the course of this investigation, LPA obtained Client and Staff rosters and documentation for Resident #1 (R-1). LPA interviewed the Facility Administrator, Staff #1 (S-1) and Staff #2 (S-2). LPA was unable to interview Resident #1 (R-1) as R-1 is deceased. LPA interviewed Resident #2 through Resident #4 (R-1 through R-4). Today, LPA discussed findings with Mr. Yoshisato (Director of Community Relations) as Ms. Biely was unavailable.

Refer to LIC 90999C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

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-20200902172202

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: 05/03/2021

NARRATIVE

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Allegation: Staff did not safeguard resident's medication. During the course of this investigation, interviewed staff indicated that staff safeguard residents’ medication. Interviewed staff indicated the med techs administer medication in the morning (breakfast), noon (lunch), afternoon (dinner) and bedtime. Interviewed staff indicated all medication including as needed medication (PRN) are administered as per Physician’s orders and are documented in the Medication Administration Record (MAR). Interviewed staff indicated medication is safeguarded and locked until the medication is administered. Interviewed staff indicated med techs exchange the key to the medication locked storage and conduct a narcotic count upon the start of each shift. Interviewed staff have not observed nor received any complaints/concerns of staff taking residents medications. Interviewed staff indicated they are trained in Mandated Reporting and Resident Rights. Interviewed Residents indicated staff provide their medication as ordered by their Physician’s and is given on a timely and consisted manner. Interviewed Residents indicated they do not have any concerns about the staff administrating their medication. Interviewed Residents indicated they have not observed nor heard of any staff taking residents medication. Staff and Resident interviews do not corroborate this allegation.

Allegation: Staff did not administer medication to resident. During the course of this investigation, interviewed staff indicated that staff administer medication as per Physician’s orders. Interviewed staff indicated the med techs administer medication in the morning (breakfast), noon (lunch), afternoon (dinner) and bedtime. Interviewed staff indicated all medication including as needed medication (PRN) are administered as per Physician’s orders and are documented in the Medication Administration Record (MAR). Interviewed staff have not observed nor received any complaints/concerns of staff not administrating residents medication. Interviewed staff indicated they are trained in Mandated Reporting and Resident Rights. Interviewed Residents indicated staff provide their medication as ordered by their Physician’s and is given on a timely and consisted manner. Interviewed Residents indicated they do not have any concerns about the staff administrating their medication. Interviewed Residents indicated they have not observed nor heard of any staff taking residents medication. Staff and Resident interviews 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 and a hard copy was provided via email for signature. Appeal Rights were provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021

LIC9099 (FAS) - (06/04)

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