198603374-7-21-2023-28-AS-RORN-CV7UVA-20230830155449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603374
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:31:16 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
07/14/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230714150320

FACILITY NAME:	ARCADIA LIVING LLC		FACILITY NUMBER:	198603374
ADMINISTRATOR:	JINGFANG JENNIFER ZHANG		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BOULEVARD		TELEPHONE:	(626) 447-0106
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	130	CENSUS: 74	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jennifer Zhang		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff did not assist the resident with bathing as needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Jennifer Zhang and explained the reason for the visit.
The purpose of the visit is to investigate the above allegation.
At today's visit Resident and Staff Roster were submitted.
Interview was conducted with the Administrator and Staff S1 - S 3 at 1:20 PM.
Interview was conducted with Home Health Supervisor and another Home Health Representative at 1:50 PM.
Interview was conducted with Resident's R1- R6 from 1:55 PM to 3:00 PM.
File for Resident R 1 was reviewed and Emergency ID Page, Daily Wellness Log, Shower Log Home Health Sign In Sheet and Physician's report was submitted.
In regards to the allegation Facility staff did not assist the resident with bathing as needed, based on interviews conducted and information gathered Resident R 1 stated that she gets assistance with bathing 2x a week and feels it is taken care of by Home Health.
5 out of 5 resident's on shower log stated that they have received assistance with showering weekly

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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-20230714150320

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: 07/21/2023

NARRATIVE

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and staff will help and are very good.
Staff interviewed stated that Resident R 1 has received assistance with bathing 2x a week from home Health and will assist with transfer from wheelchair to bed.
1 staff stated that R1's mom stated to take her off shower schedule because Home Health will provide assistance with bathing.
Interview with Home Health supervisor who stated that Home Health comes to the facility 2x a week for wound care and bathing 2x a week. Stated they log in at facility and provide wound care and showering services.
Interview with Home Health bather who stated she logs in at facility and has bathed R1 2x a week.
Home Health Sign In Sheet signed in from 05/15 to 07/21 by a representative from Home Health.
Daily Wellness log on 05/16 states that Home Health for wound care and shower service.

Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Administrator. A hard copy of this report was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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