198603012-7-2-2024-28-AS-TVAO-D7FSQG-20240723140444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603012
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:31:37 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
06/25/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240625162907

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:	07/02/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator Laurie Gallegos		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Broken furniture not maintained by facility staff presents a hazard.
Facility staff do not serve quality meals to resident(s).
Facility staff did not make menus available upon request.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 07/02/2024 regarding the above allegations. LPA Ramirez was met by Administrator Laurie Gallegos and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 3 interviews (S1 – S3), Attempted interview of Resident#6 (R6), Interview of Resident# 1-5 (R1-R5) copies of Resident#1-6 (R1-R6): Identification and Emergency Information form, Physician Report, Hospice Care plan, copy of facility sample menu, copy of grocery receipts dated 7/1/24 and 7/2/24 and physical plant tour.

See 9099-C for continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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-20240625162907

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: 07/02/2024

NARRATIVE

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The investigation revealed the following. Regarding Allegation(s): - Broken furniture not maintained by facility staff presents a hazard- It is alleged the facility allows residents to sit in broken recliners and does not repair them. Three (3) out of the three (3) staff interviewed deny this allegation. Five (5) out of the five (5) residents interviewed deny this allegation. R6 was unable to be interviewed at this time. R6 has relocated to another facility. On 7/2/2024, at 2:18pm, LPA Ramirez attempted to contact R6 but was unable to make contact. On 7/2/2024, at approximately 10:38 am, LPA Ramirez entered the facility. LPA Ramirez conducted physical plant inspection around 10:45 am and did not observe the facility to be in disrepair. LPA inspected living room area and observed six (6) recliners. Five (5) out of the six (6) recliners each had a resident’s first name taped to the top cushion of the recliner. LPA Ramirez observed the recliners to be in good repair and working to their original design. LPA Ramirez observed two (2) out of the five (5) residents resting in their own recliners during inspection. 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.

Facility staff do not serve quality meals to resident(s)- It is alleged staff do not provide nutritious meals to residents based on their health needs. Three (3) out of the three (3) staff interviewed deny this allegation. Five (5) out of the five (5) residents interviewed deny this allegation. R6 was unable to be interviewed at this time. R6 has relocated to another facility. On 7/2/2024, at 2:18pm, LPA Ramirez attempted to contact R6 but was unable to make contact. During physical plant tour LPA Ramirez observed a supply of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. All food was observed to be stored, prepared and served in a safe and healthful manner during inspection. At 11:10 am, LPA Ramirez observed Staff#1(S1) stuffing and rolling egg rolls and slicing onions to add to a noodle stir fry dish. LPA Ramirez observed various packaged frozen meats and seafood, pre-cooked frozen meats, frozen vegetables, various fresh fruits and vegetables, several cartons on eggs, several gallons of milk, several gallons of orange juice, and desserts. 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.

See 9099-C for continuation.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240625162907

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: 07/02/2024

NARRATIVE

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Facility staff did not make menus available upon request- It is alleged staff did not make menu available for R6’s family upon request. Three (3) out of the three (3) staff interviewed deny this allegation. R6 was unable to be interviewed at this time. R6 has relocated to another facility. On 7/2/2024, at 2:18pm, LPA Ramirez attempted to contact R6 but was unable to make contact. Five (5) out of the five (5) residents interviewed deny this allegation. Per Title 22, Division 6, Chapter 8, Article 10. Food Service 87555 General Food Service (a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. (6) In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. Facilities licensed for less than sixteen (16) residents shall maintain a sample menu in their file. Menus shall be made available for review by the residents or their designated representatives and the licensing agency upon request. LPA Ramirez observed a sample menu in resident records during file review. 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.

No deficiencies were cited during this investigation. Exit interview was conducted. A copy of this report was provided via email due to printer problems.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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