198603012-10-5-2023-28-AS-TVAO-CWSUC5-20231020152722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603012
Report Date: 10/05/2023
Date Signed: 10/05/2023 12:17:38 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
09/26/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230926164114

FACILITY NAME:	INSPIRED ELDERLY CARE LIVING		FACILITY NUMBER:	198603012
ADMINISTRATOR:	GALLEGOS, LAURIE		FACILITY TYPE:	740
ADDRESS:	1438 E PORTNER STREET		TELEPHONE:	(909) 240-1321
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	6	CENSUS: 5	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lilibeth Alcala, Staff		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not seek medical attention in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation of facility did not seek medical attention in a timely manner. LPA arrived unannounced and met with staff, Lilibeth Alcala. Administrator, Laurie Gallegos, arrived shortly after to assist with the visit. The purpose of the visit was explained.

LPA obtained copies of the staff and resident rosters, reviewed Resident #1’s file, and interviewed the administrator, 2 Staff, family members, and a resident.

For allegation, Facility did not seek medical attention in a timely manner. It is alleged that the Resident #1 (R1) had not eaten in several days and was declining due to not being able to swallow. The facility knew of the conditions but did not seek medical attention.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20230926164114

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: INSPIRED ELDERLY CARE LIVING	FACILITY NUMBER: 198603012
	VISIT DATE: 10/05/2023

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

Based on interviews and documentation, R1 moved in on 9/15/23 and passed away on 10/4/23. R1 was weak and ate very minimal when admitted to the facility. R1 received home health services and they stated the nurse was aware of the declining conditions. The administrator indicated that a therapist came out to check on the swallowing at one point. The family members also came daily and were informed about R1 not eating. They also tried to feed R1 but was not successful. Staff stated R1 ate very little and later did not want to intake anymore food/supplement.

LPA interviewed the family member who was the power of attorney for R1’s medical services. Per the family member, they contacted the doctor and informed of the non-consumption. R1 was later placed on hospice due to the decline in health. The administrator communicated with them often regarding R1’s condition. Family members stated they were pleased with the care provided by all the staff at the facility. They felt the staff were compassionate and took good care of the residents.

Staff interviewed stated they will contact the administrator for guidance if they see any change of condition in a resident. If the resident is on hospice, they will notify the nurse. For others, they would contact 911 and seek medical attention right away if necessary. One of the residents interviewed enjoys living here and thinks the staff are great and attentive.

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 the administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2