198603374-5-28-2021-28-AS-MVAO-C3ZSJM-20210615135521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603374
Report Date: 05/28/2021
Date Signed: 05/28/2021 11:15:09 AM

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
12/14/2020 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201214092355

FACILITY NAME:	ARCADIA LIVING LLC		FACILITY NUMBER:	198603374
ADMINISTRATOR:	BIELY, NOEMI		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BOULEVARD		TELEPHONE:	(951) 907-9888
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	130	CENSUS: 38	DATE:	05/28/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Noemi Biley		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff not servng adequate food service to resident's
Staff mismangaing residents medication

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Christine Wong and Alberto Lopez conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with Administrator, Noemi Biely and explained the purpose of the visit.

The investigation consisted of the following: The initial complaint visit was conducted on 12/18/20. During the initial visit, LPA conducted a safety inspection of the facility including the lobby area, medication room, nurse office, kitchen, dining area and resident room#214 via face time and no safety hazards were observed. LPA also interviewed administrator. LPA also requested resident and staff roster with phone #, recent facility menu and recent in-service training log for Med-Tech. LPA also interviewed staff and residents on 05/6/2021.

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

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-20201214092355

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: ARCADIA LIVING LLC	FACILITY NUMBER: 198603374
	VISIT DATE: 05/28/2021

NARRATIVE

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The investigation revealed of the following: Allegation#1 “Staff not serving adequate food services to residents’” LPA interviewed five residents, and all denied the allegation and reported the facility always provided adequate and variety food to the residents. Residents reported the facility used the disposable utensils for meals during the lock down of COVID-19. LPA interviewed staff and denied the allegation and reported they did not provide any fast food or "to go" food to the residents. They always provided balanced meal, cooked food and variety of food to residents.

Allegation#2 “ Staff mismanaging residents’ medication.” LPA interviewed residents and all denied the allegation and reported it never happened on them. LPA interviewed staff and reported they always provide the prescribed medication to residents according to the doctor’s order. The medication staff also received yearly training for medication administration.

Based on LPA's interviews and documents obtained, although the allegations 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 allegations are UNSUBSTANTIATED.

Exit interview conducted and the copy of the report and appeal right was provided to the administrator Noemi Biely.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

LIC9099 (FAS) - (06/04)

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