198603374-3-27-2023-28-AS-FFIS-CWRTG7-20231019144239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603374
Report Date: 03/27/2023
Date Signed: 03/27/2023 04:03:28 PM

Substantiated

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
10/10/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20221010164036

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: 55	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jennifer Zhang, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility neglected resident's call requests after sustaining a fall.
Facility staff failed to seek medical evaluation to resident after sustaining a fall.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/18/22. The findings remain as Substantiated. ***

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to the facility regarding the above-mentioned allegations. Upon arrival at the facility, LPA met Jennifer Zhang, Administrator and explained the purpose of today’s visit.

The initial unannounced complaint investigation visit was conducted on 10/18/22. Licensing Program Analyst (LPA) Tao conducted an initial visit and met administrator, Jennifer Zhang. Investigation consisted of interviews of staff from Staff #1 (S1) through Staff #6 (S6) and attempted to interview Staff#7 (S7); interviews of residents from resident#2 (R2) through resident #5 (R5) and attempted to interview resident#1 (R1) and visitor #1 (V1); reviews of resident#1 (R1)’s record; and tour of the facility.
(- continued in LIC 9099 C-)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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-20221010164036

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/28/2023 Section Cited CCR 87415(a)(3)	1 2 3 4 5 6 7	In facilities caring...and one employee shall be on call and capable of responding within ten minutes. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide in service training regarding responding timely to call button request/ call system to resident. Provide proof of correction to Licensing by 3/28/23. POC was cleared on 10/18/22 from the initial complaint investigation.
	8 9 10 11 12 13 14	Staff responded to residents' call button in more than 30 minutes which poses an immediate Health, Safety, Personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 05/04/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide (1) in-service training educating staff regarding the providing of medical assistance and evaluation to residents and (2) administrator provided a written staffing plan to ensure sufficient number of staff to provide services necessary to meet residents needs by 04/03/23.
	8 9 10 11 12 13 14	Facility failed to provide Resident#1 a medical evaluation on a timely basis after sustaining a fall which poses a potential Health, Safety, Personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20221010164036

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: 03/27/2023

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/18/22. The findings remain as Substantiated. ***

LPA obtained copies of the staff and resident rosters, and resident #1 (R1)’s records with relevant information.

LPA Tao conducted a subsequent complaint investigation visit on 3/27/23. During the visit, LPA obtained copies of staff and resident rosters, reviewed residents’ files, interviewed staff#1 (S1), conducted a facility tour, and re-delivered findings.

The investigation consisted of resident interviews, staff interviews, residents’ files review, facility tour, and LPA’s observation.

During today’s visit on 03/27/23, LPA met administrator, Jennifer Zhang. LPA explained the purpose of today's visit regarding the above-mentioned allegations.

Investigation consisted of the following: interviews of Staff #1 (S1), reviews of resident#1 (R1)’s record; and a facility tour. LPA obtained a copy of staff and resident rosters, and R1s’ records with relevant information.

The investigation revealed the following:
Regarding the allegation “facility neglected resident's call requests after sustaining a fall," it was alleged that staff did not respond to multiple call button requests for assistance from resident after sustaining a fall. LPA attempted to interview resident#1 but unable to interview since resident discharged on 10/17/22 and responsible party did not answer LPA's multiple calls. Four (4) out of five (5) residents stated it took staff about 30 minutes or more to respond their call button requests and come to residents' room to assist residents. One (1) out of five (5) residents stated it took about 3 minutes for staff to come to assist. Interviewed six staff from staff#1 (S1) to staff #6 (S6) and they all denied the allegation. Three (3) staff stated staff did not respond to resident#1's call button request on 10/01/22 because R1 did not press the call button for help. The call button was pressed by staff who found R1 after sustaining a fall. LPA toured the facility with administrator and went to room #110 and #112 to test the call button requests, staff responded and came to the residents’ room in 5 minutes. However, resident interviews revealed facility did not respond resident's call requests on a timely basis to assist residents. (- continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20221010164036

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: 03/27/2023

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/18/22. The findings remain as Substantiated. ***

Regarding the allegation “facility staff failed to seek medical evaluation to resident after sustaining a fall," it was alleged that facility staff did not seek a medical evaluation for resident#1 after sustaining a fall. Five (5) out of five (5) residents interviewed could not corroborate the allegation.

LPA interviewed staff. Five (5) out of six (6) staff stated they did not seek a medical evaluation for resident#1 (R1) after R1 sustained a fall. File reviews revealed facility did not seek medical evaluation for R1 after the incident on 10/01/22. Per record review, R1 stated R1 hit his/her head on the carpet floor and had altered level of consciousness (LOC) for an unclear duration. Therefore, staff failed to seek medical evaluation to resident after sustaining a fall.

Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. 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 and appeal rights were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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