197607476-6-24-2022-28-AS-FFIS-CG5W3X-20220708165641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607476
Report Date: 06/22/2022
Date Signed: 06/24/2022 04:17:26 PM

Unsubstantiated

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
08/18/2020 and conducted by Evaluator Elizabeth Ceniceros

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200818133526

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:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director of Resident Services, Jennifer Lan, RN		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staffing levels insufficient to meet the needs of the residents.

Facility staff do not have proper training.

INVESTIGATION FINDINGS:

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Licensing Program Analyst/Retired Annuitant (LPA/RA) Elizabeth Ponce Ceniceros made an unannounced visit to the facility and was greeted by Staff (Director of Resident Services, Jennifer Lan, RN). The purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. However, the facility is under a new change of ownership, effective 02/17/21; therefore, LPA/RA Ceniceros will mail to (former) Licensee.

An Initial 10-Day virtual visit was conducted by LPA Bonnie Tao on 08/27/20 (via virtual video conferencing) with Administrator Noemi Biely due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. During the virtual, video conference call with Administrator Biely, LPA Tao conducted a virtual tour of the facility’s physical plant. LPA interviewed two (2) residents in care and seven (7) facility staff. LPA obtained copies of the LIC 500 and resident roster. LPA requested pertinent documentation (training agency contracts, Administrator Certificate, Disaster Drills, Fire Drills, New Employee Orientation for Direct Care Staff (Day 1 - Day 5) & Completion of Certificates, All Staff Meeting Sign-in sheets, Training Log Sign-in sheets (January 2020 to August 2020).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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-20200818133526

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: 06/22/2022

NARRATIVE

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Regarding Allegation #1: this investigation revealed that the facility has sufficient and competent staff to provide the services necessary. A review of the facility’s training agency contracts (accompanied with Certificates of Completion) documents staffing personnel are sufficient in numbers and competent to provide the services necessary to meet the needs of the residents.

Based on the evidence gathered and interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation of OTHER: Staffing levels insufficient to meet the needs of the residents is found to be UNSUBSTANTIATED.

Regarding Allegation #2: this investigation revealed that the facility provides ongoing training to personnel; such as, New Employee Orientation for Direct Care Staff (Day 1 – Day 5) and Training Logs (Topics: Aging Process & Physical Limitations of the Elderly, Special Needs of the Elderly, Introduction to Dementia, Personal Care Services: Assistance with ADL’s, Care Plan, Restricted & Prohibited Health Conditions, Proper Communication; Medication Policies & Procedures, Resident Rights, Elder Abuse Reporting) based on the Training Log Sign-in Sheets (January 2020 to August 2020) provided by the facility.

Based on the evidence gathered and interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation of OTHER: Facility staff do not have proper training is found to be UNSUBSTANTIATED.

No exit interview was conducted as the facility closed its doors, effective 02/17/2021. A copy of the Complaint Report and Appeal Rights and Civil Penalty will be sent certified mail (via USPS) to the (former) Licensee of Vista Cove at Arcadia, Inc. (#197607476).

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

LIC9099 (FAS) - (06/04)

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