197801052-8-3-2023-28-AS-RORN-CUKLF3-20230810084229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801052
Report Date: 08/03/2023
Date Signed: 08/03/2023 12:20:47 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
10/13/2022 and conducted by Evaluator Alberto Lopez

PUBLIC

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:	0	CENSUS: 112	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	12:11 PM
MET WITH:	Claudia Ruiz, Business Manager		TIME COMPLETED:	12:24 PM

ALLEGATION(S):

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Facility staff are not providing transportation services to residents

INVESTIGATION FINDINGS:

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**Please note: This LIC9099 and LIC9099-C report will supercede the reports dated 10/17/22, to include specific additional details of the investigation; However, the findings will remain unchanged- Unsubstantiated.**
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).
The investigation revealed the following:
(Report continued on LIC9099-C...)

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: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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-20221013103602

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: WEST PARK SENIOR LIVING	FACILITY NUMBER: 197801052
	VISIT DATE: 08/03/2023

NARRATIVE

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Regarding allegation: Facility staff are not providing transportation services to residents.
It is alleged that R1 scheduled transportation services through the facility with a month’s notice, and staff cancelled services at the last minute, prompting R1 to reschedule an important medical appointment R1 had. Per interview with R1, R1 was scheduled to have a procedure done on 10/14/22 where anesthesia would be used, and R1 would not be able to drive. R1 was an independent resident who possessed a driver license and had their own car. R1 was advised by R1’s medical provider that due to the anesthesia, R1 would be unable to drive and would require either a family member or someone from the facility to pick-up R1 after the procedure was completed. R1 stated that transportation services at the facility for medical appointments were only on Tuesday’s and Thursday’s. R1 ensured R1’s appointment coincided with one of those days so that R1 could be picked up (R1 states 10/14/22 was a Thursday, but the date was actually a Friday). On Wednesday, the day before R1’s scheduled procedure, R1 stated that S2 informed R1 that S3 could not pick up R1 from the hospital. R1 was upset and did not ask for a reason why staff could not be pick-up R1. R1 believes the reason why staff told R1 they couldn't pick-up R1 was because the driver’s (S3) shift ends at 4PM and would not return to the facility before S3’s scheduled end time from work. R1 stated the facility did not give R1 a 24-hour notice, so that R1 could find another form of transportation. During interviews conducted with staff, (4) of (4) staff denied the allegation. S1 stated that due to S3’s scheduled end time being 4PM, arrangements were made for S4 to pick-up R1 from the hospital. The hospital where R1 would be picked up was further than the facility’s limited travel radius, and S3 would not be back on time, as R1 requested a pick-up of 3:30PM. Per S4, when S4 spoke to R1 on Tuesday, 10/13/22 to confirm the pick-up on Wednesday, 10/14/22, R1 informed S4 that the appointment was actually on Thursday (10/15/22). S4 informed R1 that S4 could not pick-up R1 that day due to being off from work, Therefore, R1 was notified with sufficient time to find alternate transportation. Per S2, R1 and S2 spoke the day before the scheduled pick-up and drop-off and R1 was informed that S3 could drop-off R1 but was unable to pick-up R1 due to time constraints. S2 stated to be willing to assist R1 with finding alternate transportation services, however R1 was upset when S2 provided R1 the information. R1 cussed at S2 and left without return or contact with S2. 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 for outside services.

(Report Continued on LIC9099-C...)

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PARK SENIOR LIVING	FACILITY NUMBER: 197801052
	VISIT DATE: 08/03/2023

NARRATIVE

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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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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