197608072-8-30-2024-28-AS-LHIS-D9EL8T-20240924083226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608072
Report Date: 08/30/2024
Date Signed: 08/30/2024 04:14:15 PM

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
08/13/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240813085334

FACILITY NAME:	EVERGREEN SENIOR CARE		FACILITY NUMBER:	197608072
ADMINISTRATOR:	EVANGELINA REYES		FACILITY TYPE:	740
ADDRESS:	528 HOWARD STREET		TELEPHONE:	(626) 284-0503
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	14	CENSUS: 14	DATE:	08/30/2024
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Evangelina Reyes, Administrator		TIME COMPLETED:	04:29 PM

ALLEGATION(S):

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Facility is not following the posted menu.
Staff is coercing residents to receive hospice care.

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPA) Alberto Lopez made a subsequent unannounced visit to investigate the above allegations. LPA met with Administrator Evangelina Reyes and discussed purpose of the visit.

LPA made initial visit on 08/20/2024 and conducted interviews with "Licensee" (L) and seven (7) staff (S#1-S#7) and four (4) residents (R#1-R#4) and reviewed Admissions Agreement, menu and food supplies as well as taking tour of facility.

The investigation revealed: Allegation Facility is not following the posted menu. It is alleged that facility is not following the posted menu for meals. LPA interviewed seven (7) staff and five (5) of seven (7) staff denied the allegation. LPA Interviewed four (4) residents and four (4) of four (4) residents were not able to corroborate the allegation. "Licensee" denied the allegation. Ten (10) residents were not able to answer questions. LPA was present during dinner time and the food served was what the menu called for. There is not enough evidence to substantiate this allegation. (continued on 9099D)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

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-20240813085334

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: EVERGREEN SENIOR CARE	FACILITY NUMBER: 197608072
	VISIT DATE: 08/30/2024

NARRATIVE

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Allegation: Staff is coercing residents to receive hospice care. It is alleged that facility staff is coercing facility residents to received Hospice services.

The Investigation revealed: LPA interviewed Licensee (L), and seven (7) staff. Five (5) of seven (7) staff denied the allegation or stated they did not know anything about this allegation. Licensee denied the allegation. LPA interviewed four (4) residents and four (4) of four (4) residents could not collaborate the allegation. S1 stated that one resident was transfer from one Hospice agency to another but not coerced. S6 stated that one resident was "pushed" into hospice. However resident was not on Hospice during visit. There is no evidence that residents are being coerced. There is insufficient evidence to substantiate this allegation.

Based on statements and interviews conducted with residents and staff and reviewed of files and documentation, there was not enough supportive evidence to corroborate the allegation.

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

Exit interview, and a copy of this report and Appeals Rights was provided to Administrator Evangelina Reyes

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

LIC9099 (FAS) - (06/04)

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