197607820-10-9-2020-28-AS-MVAO-BUEPHG-20201015111954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 12/26/2019
Date Signed: 10/09/2020 12:00:08 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
12/20/2019 and conducted by Evaluator Natasha Clay

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191220160947

FACILITY NAME:	REGENCY PARK ASTORIA		FACILITY NUMBER:	197607820
ADMINISTRATOR:	ANNABELLE ARGENAL		FACILITY TYPE:	740
ADDRESS:	925 EAST VILLA STREET		TELEPHONE:	(626) 796-4303
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	220	CENSUS: 72	DATE:	12/26/2019
		UNANNOUNCED	TIME BEGAN:	09:36 AM
MET WITH:	Lourdes Menchaca, Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility failed to provide adequate food service to residents in care
Resident's dietary needs are not being met by the facility
Facility staff failed to ensure resident had transportation to medical appointment(s)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Clay conducted an unannounced initial 10-day Complaint visit to investigate the above allegations. Upon arrival LPA met with Executive Director, Lourdes Menchaca and explained the purchase of today's visit. LPA obtained the staff roster and resident roster. During today's visit LPA conducted (6) staff interviews and (7) resident interviews. The investigation consisted of the following: LPA collected records; menu, alternative menu, resident list dietary restrictions, admission agreement, dietary evaluation, in-service procedures for outbreak of acute illness, resident (#R1) records (face sheet, physician report, admission agreement, needs and services plan and functional capability), incident report. In addition, LPA toured the dining room at approximately 10:15 a.m. with Executive Director and observed the dining room assisted living and memory care unit, activity lounge, bistro, commercial kitchen, food supply and food pantry. LPA interviewed the Executive Director. According to LPA interview, Executive Director stated that there was an epidemic outbreak around 12/02/19 and residents were discouraged from consuming meals in the dining room, meals were delivered to resident rooms and housekeeping standards were maintained in all departments.
(LIC9099C continued on the next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Natasha Clay	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2019

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 3

Control Number 28-AS-20191220160947

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: REGENCY PARK ASTORIA	FACILITY NUMBER: 197607820
	VISIT DATE: 12/26/2019

NARRATIVE

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Executive Director denies that the facility staff failed to provide adequate food service to residents, failed to adhere to dietary needs in the physician order and failed to ensure residents had transportation to medical appointments. LPA completed a record review of incident report to CCLD dated 12/10/19 regarding facility outbreak of an acute illness, notification to resident and authorized representatives, acute infection surveillance line list, personal protective equipment supply list, universal precaution procedures, housekeeping procedures to prevent acute illness. During this acute phase the dining room was shut down, residents and authorized representatives, visitors were notified, posting were included on all doors and in the elevators regarding standard of care and universal precautions. Facility staff maintained housekeeping procedures according to the infection surveillance and in-service housekeeping procedures was conducted with all departments. LPA interviewed Wellness Director who stated that signs and symptoms of the first case of an outbreak occurred beginning 11/28/2019 - 12/15/2019, and the physician did not order a sample to confirm diagnosis since illness was limited 1-2 people that were asymptomatic and assessed at the hospital, none of these residents were confirmed to have the acute infection and none were admitted to the hospital for such. According to staff interviews, staff followed universal precautions and housekeeping preparation immediately which included resident isolation from the dining room. The facility staff encouraged resident's personal right to access any areas excluding the dining room and activity room and meals were served in resident rooms only during this time to prevent the spread of infection.

In regard to the allegation: Facility failed to provide adequate food service to residents in care
LPA conducted interviews with (6) staff and (7) residents. All staff deny inadequate food service. All residents deny inadequate food service before, during and after the acute illness outbreak and report (3) meals and snacks are available and residents can choose from the alternative food menu. LPA toured the kitchen with Executive Director at approximately 10:15 a.m. and observed the dining room assisted living and memory care unit, activity lounge, bistro, commercial kitchen, food supply and food pantry. Kitchen was observed to be clean and sanitary and the food supply met title 22 guidelines. Notifications and postings included menu, alternative menu, dietary orders, housekeeping schedule, housekeeping procedures. Resident #1 stated food is sufficient but prefers cuisine from home country. LPA completed a record review of the current dietary evaluation report and did not find any discrepancies. LPA did not find evidence the facility failed to provide adequate food service to the residents in care.

In regard to the allegation: Resident's dietary needs are not being met by the facility
Based on staff interviews meals are served to resident's based on food choices and dietary restrictions that are included in the physician order.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Natasha Clay	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2019

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191220160947

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: REGENCY PARK ASTORIA	FACILITY NUMBER: 197607820
	VISIT DATE: 12/26/2019

NARRATIVE

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The staff is in-serviced on resident's dietary needs from the dietary profile and must refer to the physician order and residents are given dignity and freedom of choice and staff encourages resident preferences based on their healthcare needs. If residents choose to deviate from physician order pertaining to the dietary restrictions, the physician will be called for authorization and care plan will be updated as needed. According to Wellness Director residents are encouraged to comply with their physician order. LPA did not find evidence that the residents dietary needs are not being met by the facility.

In regard to the allegation: Facility staff failed to ensure resident had transportation to medical appointment(s)

Based on staff interviews transportation is included as part of the admission agreement. Based on staff interviews, residents are encouraged to adhere with facility planning schedule and policy and transportation services are available for leisure and for medical appointments on designated days, residents are asked to plan in advance according to the facility policy in order to accommodate all of the residents. Facility staff is available to assist residents with medical arrangements and are given recommendations for alternative transportation services if medical appointments schedules do not meet facility requirements. According to resident interviews, facility transportation is available to residents for medical appointments and outings and residents have access to community transportation services or assistance from family or authorized representatives. LPA did not find evidence that facility staff failed to ensure residents had transportation to medical appointments.

Although the alleged allegation may have happened or is valid, there if not a preponderance of evidence to prove the alleged violation did or did not occur therefore, the allegations are found to be UNSUBSTANTIATED.

Exit interview conducted with Executive Director, Lourdes Menchaca, and a copy of this report is being provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Natasha Clay	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2019

LIC9099 (FAS) - (06/04)

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