197801052-10-17-2022-28-AS-RORN-CUKLF4-20230810084231

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801052
Report Date: 10/17/2022
Date Signed: 10/17/2022 04:07:28 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
10/13/2022 and conducted by Evaluator Valeria Maldonado

COMPLAINT CONTROL NUMBER: 28-AS-20221013103602

FACILITY NAME:	WEST PARK SENIOR LIVING		FACILITY NUMBER:	197801052
ADMINISTRATOR:	IRBY, LORI		FACILITY TYPE:	740
ADDRESS:	801 CYPRESS WAY		TELEPHONE:	(626) 339-5426
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	200	CENSUS: 109	DATE:	10/17/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lori Irby- Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff are not providing transportation services to residents.

INVESTIGATION FINDINGS:

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Licensing Porgram Analyst (LPA) V. Maldonado made an unannonced initial complaint visit to the facility for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Executive Director Lori Irby and explained the purpose for the visit.

During today's visit, LPA obtained a copy of the staff and resident roster, a copy of the Transportation Program Policy & Procedure, Resident#1's (R1) admissions agreement, copy of the transportation sign-up sheet for the month of October 2022, and the following documents for R1-R10: Facesheet and Physician's Report. LPA also interviewed Residents# 1-10 (R1-R10) and staff# 1-4 (S1-S4).

(Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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-20221013103602

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: WEST PARK SENIOR LIVING	FACILITY NUMBER: 197801052
	VISIT DATE: 10/17/2022

NARRATIVE

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Regarding allegation: Facility staff are not providing transportation services to residents.
During interviews conducted with S1-S4, (4) of (4) staff state that residents are being provided transportation services. Staff interviewed stated that due to limited seating on the facility bus, residents are required to sign up at the front desk ahead of time to reserve a seat, and are served on a first come-first served basis. If residents have an important appointment they need to attend and the facility bus is unavailable, they are provided options on transportation services they could contact; however, residents are responsible for paying the fees to outside services. Per the facility's Transportation Program Policy and Procedures, "A resident may request individual transportation... will be granted as the schedule allows.. include but are not limited to: Medical Appointments..." Per the resident admissions agreement, scheduled transportation will be provided to the nearest health facilities within a 12 mile radius. During interviews conducted with R1-R10, (4) of (10) residents interviewed stated they recently had issues with the transportation services at the facility, where they scheduled medical appointments with weeks in advance and on the day of their appointment, they were told they were not on the schedule. The facility made last minute arrangements for (2) of the (4) residents that experienced issues, and had another staff transport them in a community vehicle, which resulted in residents being late to their scheduled appointments.

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.

An exit interview was conducted with Executive Director Lori Irby and a copy of the report and were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC9099 (FAS) - (06/04)

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