197608358-6-1-2023-28-AS-LHIS-CSYKYH-20230620081910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608358
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:44:49 PM

Substantiated

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
05/31/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230531114715

FACILITY NAME:	LA POSADA IN SAN DIMAS		FACILITY NUMBER:	197608358
ADMINISTRATOR:	LUCY PARKER		FACILITY TYPE:	740
ADDRESS:	1452 GOLDRUSH STREET		TELEPHONE:	(909) 599-2273
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	6	CENSUS: 6	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Administrator Lorraine Lopez, and Licensee Lucy Parker		TIME COMPLETED:	02:11 PM

ALLEGATION(S):

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Staff did not provide authorized representative with resident's records

INVESTIGATION FINDINGS:

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LPA made unannounced visit to investigate the above allegation. LPA met with Socorro Shook DSP and explained the purpose of the visit. Licensee Lucy Parker and Administrator Ms. Lopez showed up a short time later and LPA explained the purpose of the visit.

The investigation revealed the following: regarding the allegation "facility did not provide resident's authorized representative records in a timely manner”, it is alleged that on Wednesday, May 24, 2023, the facility received a formal request via Titian Legal services who are authorized to obtain a copy of all of R1's records. The request was made by the resident's legal representative. They were due on Friday, May 26, 2023. Facility's Licensee stated the formal request was received on May 26, 2023. The Licensee could not provided documentation to collaborate the date. Licensee stated that the documents are ready to be picked up by Titian Legal Services and that they are scheduled to be pick up tomorrow 06/02/2023.

(Continued on 9099C)

Substantiated

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: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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-20230531114715

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: LA POSADA IN SAN DIMAS	FACILITY NUMBER: 197608358
	VISIT DATE: 06/01/2023

NARRATIVE

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According to Licensee, Authorized representative was schedule to pick them up on 05/31/2023 but did not. Licensee stated it took longer than expected because Licensee had to review documentation to make sure she could release the information. Documents were not provided within the 2 day required period.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency is being cited according to Title 22, Division 6 Health and Safety Code, Chapter 3.2 Residential Care Facilities for the Elderly Article 02.5 Resident's Bill of Rights. Refer to LIC 9099D.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230531114715

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: LA POSADA IN SAN DIMAS	FACILITY NUMBER: 197608358
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/02/2023 Section Cited HSC 1569.269(a)(21)	1 2 3 4 5 6 7	Enumerated rights; severability. Residents....shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement was not met evidenced by:	1 2 3 4 5 6 7	Facility will ensure that Health and Safety Code 1569.269 is met at all times. Additionally, the facility will submit a statement stating that they understand and will comply with this Health and Safety Code to CCLD by 06/02/2023.
	8 9 10 11 12 13 14	Based on record review, the facility received a formal request for resident's records on 05/24/23 and failed to provide the records within 2 business days, as required per regulation, which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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