198603374-6-23-2021-28-AS-MVAO-C5RQ2F-20210810114703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603374
Report Date: 06/23/2021
Date Signed: 06/23/2021 05:26:38 PM

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
01/04/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210104155128

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: 40	DATE:	06/23/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Miles Yoshisato, Director of Business Development		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not notify resident's authorized representative of incident involving resident.
Staff did not provide assistance to resident in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with Miles Yoshisato and explained the purpose of the visit.

The investigation consisted of the following:

On 1/12/21, LPA Chan conducted a telephone interview with the Administrator. LPA also requested copies of the Staff and Resident rosters including contact numbers, and documents pertaining to Resident #1 (R1): Admission Agreement, Appraisal/Needs and Services Plan, current Physician's Report, hospital discharge documents, and Unusual Incident Reports to be emailed. During today's visit, LPA Chan interviewed 3 Staff and 5 Residents. LPA was unable to interview R1 since resident had deceased.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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-20210104155128

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: 06/23/2021

NARRATIVE

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The investigation revealed the following:

Allegation #1 - Staff did not notify resident’s authorized representative of incident involving resident. Administrator Biely stated that when there are any incidents involving their residents, they would report to the authorized representative immediately or as soon as they could. She indicated that the Resident #1’s (R1) mini stroke that occurred in December 2020 was reported to the resident’s responsible party via telephone call. LPA verified with R1’s responsible party that this incident was reported when it occurred. Interviews with caregivers stated that with any usual incidents, they would inform either the MedTech or head nurse and one of them will inform the families. They do not know how soon the families are notified as they do not follow up with the incident reports. LPA interviewed the MedTech who stated that families/responsible parties are contacted right away and depending on the type of incidents, doctors are also contacted.

Allegation #2 - Staff did not provide assistance to resident in a timely manner. It is alleged that Resident #1 (R1) had to wait over an hour to be assisted with the bathroom. The Administrator and staff interviewed denied that it ever took over an hour to assist R1 to the bathroom. Staff reported that they would assist as quickly as possible when a resident pulls the call cord from the room or press the pendant. The MedTech will also assist caregivers when they are busy so that residents are tend to immediately. They do round checks about every 2 hours. 4 out of 5 residents interviewed stated that the staff provide assistance whenever they ask and would respond in a reasonable amount of time. One of the resident is independent and does not ask for assistance.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Mr. Yoshisato, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC9099 (FAS) - (06/04)

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