198601845-5-16-2023-28-AS-FFIS-CSTSJP-20230615135526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601845
Report Date: 05/16/2023
Date Signed: 05/16/2023 07:19:13 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
04/01/2020 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20200401125104

FACILITY NAME:	A SPLENDOR LIVING - THE GLENDORA INC		FACILITY NUMBER:	198601845
ADMINISTRATOR:	JACK SU		FACILITY TYPE:	740
ADDRESS:	452 SELLERS ST.		TELEPHONE:	(626) 594-0152
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91741
CAPACITY:	34	CENSUS: 12	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jason Chuang, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Questionable death.
Resident developed pressure injury due to neglect.
Lack of supervision resulting in resident wandering from the facility.
Resident's toileting needs are not being met.
Facility does not provide a safe environment for residents.
Staff denied resident hospice care.
Staff did not seek medical treatment for resident in a timely manner.
Staff are not properly trained.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation visit. During the visit, LPA met with Administrator, Jason Chuang and explained the purpose of today's visit regarding the above-mentioned allegations.

The investigation consisted of the following:
On 04/08/2020, an initial investigation visit was conducted by Licensing Program Analyst (LPA) Elizabeth Irra. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the initial complaint investigation was conducted telephonically with Ricki Corvera, (former) Assistant Administrator. LPA Irra obtained employee Phone List, staff roster and resident roster.
On 04/05/23, a subsequent visit was conducted by Licensing Program Analyst (LPA) Tao. LPA met with and interviewed current administrator, Jason Chuang. During the visit, LPA conducted resident / staff interviews and toured the physical plant. LPA obtained staff / resident roster and some residents records. LPA requested additional residents’ records. (- continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20200401125104

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 05/16/2023

NARRATIVE

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On 05/09/23, a second subsequent visit was conducted by Licensing Program Analyst (LPA) Tao. LPA met with administrator, Jason Chuang. LPA conducted staff interview of hospice care nurse; reviewed some resident records; and toured the physical plant. LPA obtained staff / resident roster and some residents records requested from last visit. LPA requested additional residents’ records including residents’ death certificates in year 2020.

On 05/16/23, a third subsequent visit was conducted by Licensing Program Analyst (LPA) Tao. LPA met with administrator, Jason Chuang. LPA obtained and reviewed residents’ records and conducted a facility tour during the visit. LPA delivered the findings and discussed the findings with administrator Jason.

Interviews of residents and staff consisted of the following:
LPA interviewed residents from resident#1 (R1) to resident #6 (R6) and attempted to interview resident #8 (R8) multiple times but failed to interview R8 due to the loss of contact after R8 moved out. LPA was unable to interview residents of resident#7 (R7), resident#9 (R9), resident#10 (R10) and resident#11(R11) due to residents were deceased in 2020.

LPA interviewed staff from staff#1 (S1) to staff#3 (S3) and staff#7 (S7). LPA attempted to interview staff from staff#4 (S4) to staff#6 (S6) multiple times but failed to interview S4 to S6 due to the loss of contact since they were no longer working at the facility.

LPA also interviewed resident#7’s family member (F1).

The investigation revealed the following:
In regard of allegation #1- “questionable death,” it was alleged that many residents have passed away and resident#9 (R9) was choked on food while staff was feeding R9 and died later that day. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. (-continued in LIC9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 28-AS-20200401125104

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 05/16/2023

NARRATIVE

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LPA attempted but unable to interview resident #8 (R8). Residents were not aware of any questionable death at the facility. LPA interviewed staff, all four (4) staff interviewed denied the allegation. LPA reviewed residents’ death reports from January to April 2020 and obtained death certificates of those death residents. All death residents (residents R7, R9, R10, and R11) were under hospice care for a period of time. Their death certificates stated their primary cause of death was acute cardiopulmonary arrest or organ failure. Per resident #9 (R9)’s record, hospice report / physician order stated R9 was on hold on all food and oral medication since March 2020 but only applied oral swab to moisture R9’s mouth. LPA interviewed resident’s family member (F1) and nurse from residents’ Hospice care. They stated the death residents were died from natural cause of death, they were on their end stage of life and their deaths were not suspicious. Thus, there was not preponderance of evidence to show residents’ death was questionable.

In regard of allegation #2- “resident developed pressure injury due to neglect,” it was alleged that resident#7 (R7) developed a sore on resident’s buttock area and staff did not notify home health or hospice nurse. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation. LPA reviewed resident#7 (R7)’s record and found R7 was on hospice. Per hospice report, hospice nurse was notified and aware of R7’s sore. R7 was under hospice nurse’s care with medical treatment. Thus, staff did not neglect resident and cause resident to develop sore.

In regard of allegation #3- “lack of supervision resulting in resident wandering from the facility,’ it was alleged that facility was not keeping facility exit doors locked and alarms on and resident#8 (R8) was wandered from the facility unnoticed. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. Residents did not know any residents wandered from the facility. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation. LPA reviewed resident#8 (R8)’s physician report, R8 did not have wandering behavior. (-continued in LIC9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 28-AS-20200401125104

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 05/16/2023

NARRATIVE

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No incident report was reported to Licensing that R8 had wandered from the facility in 2020. LPA toured the facility during the visits on 04/05/23, 05/09/23 and 05/16/23, facility exit doors were locked and alarms were on. Therefore, there was not preponderance of evidence to show facility was lack of supervision and caused resident wondering from the facility.

In regard of allegation #4- “resident's toileting needs are not being met,” it was alleged that residents are not being changed according to the schedule, and resident#10 (R10) was left in soiled diapers. LPA interviewed residents, six (6) out of seven (7) residents interviewed stated their toileting needs were met and staff would assist them with changing diapers when needed. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation. LPA reviewed R10’s records, resident was on hospice, rotated in bed every two hours and R10’s diaper was checked along with the rotation. LPA toured the facility during each visit and did not observe any residents were left in soiled diapers. Thus, there was not preponderance of evidence to show facility failed to meet resident’s toileting needs.

In regard of allegation #5- “facility does not provide a safe environment for residents,” it was alleged that facility had wheelchairs and oxygen tanks laying around; staff did not ensure exit doors/sliding doors, laundry/storage room doors and break room doors were locked; and facility did not provide COVID-19 supplies to staff during the COVID -19 pandemic. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation and stated they had sufficient COVID -19 supplies / personal protective equipment (PPE) supplies during 2020. LPA toured the facility on each investigation visits and observed no wheelchairs and oxygen tanks were laying around and all exit doors/sliding doors, laundry/storage room doors and break room doors were locked. LPA checked facility’s COVID -19 supplies / personal protective equipment (PPE) supplies on each facility tours, sufficient of 30 days of supplies were observed. Therefore, facility did not fail to provide a safe environment for residents. (-continued in LIC9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 28-AS-20200401125104

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 05/16/2023

NARRATIVE

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In regard of allegation #6- “staff denied resident hospice care,” it was alleged that resident#9 (R9) did not get hospice services. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation. Per R9’s record reviews, resident’s hospice care nurse had provided services to R9 at least twice weekly since 01/02/20. Therefore, staff did not deny resident’s hospice care.

In regard of allegation #7- “staff did not seek medical treatment for resident in a timely manner,” it was alleged that facility staff did not provide resident #7 (R7) with medical treatment timely for resident’s sore to become “black” on buttock area. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation. Per R7’s record reviews, hospice nurse was providing medical treatment to R7’s sore before it became “black” and R7’s plan of care was in place. Thus, resident’s medical treatment was provided in a timely manner.

In regard of allegation #8- “staff are not properly trained,’ it was alleged that facility staff was not getting training on residents’ care. LPA interviewed residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. Residents stated staff were able to provide care as residents needed. LPA attempted but unable to interview resident #8 (R8). LPA interviewed staff, all four (4) staff interviewed denied the allegation and stated they got training annually. Per staff record reviews, staff received annual training on residents’ care in 2020. Therefore, staff were getting training on residents’ care.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

(-continued in LIC9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 28-AS-20200401125104

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 05/16/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator, Jason and findings were discussed. A copy this report was provided to Administrator at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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