198603535-7-28-2023-28-AS-RORN-CUCTNV-20230803145321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/28/2023
Date Signed: 07/28/2023 03:32:57 PM

Substantiated

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
09/02/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220902163645

FACILITY NAME:	SANTA ANITA ASSISTED LIVING		FACILITY NUMBER:	198603535
ADMINISTRATOR:	DEOSO, GEMMA		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVENUE		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	150	CENSUS: 114	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Yumi Ludwig		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Resident has severe case of scabies

INVESTIGATION FINDINGS:

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***Please note: This LIC9099 report supersedes the LIC9099 report dated 11/18/2022 to clarify and correct the citation on the deficiency page (LIC9099D), however, the finding will remain the same. ***

Licensing Program Analyst (LPA) Christine Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with receptionist Tyryse Robinson and explained the reason of the visit. Shortly after, LPA met with Wellness Directot Yumi Ludwig and assisted with the visit.

The investigation consisted of the following: On 09/07/2022, LPA Wong conducted a health and safety check. LPA toured the facility with LVN Mia Cody and observed that the facility is clean and in good repair.

(See LIC 9099C for continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20220902163645

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
	VISIT DATE: 07/28/2023

NARRATIVE

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LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Restrooms, hand washing basins, toilets and bathtub/showers are operable. There are no immediate health and safety concerns. The following documents were collected which included: staff and resident roster. Resident#1-#3 (R1-R3) LIC601, physician report, resident appraisal, and admission agreement. On today's date, LPA interviewed five staff (S1-S5) and six residents (R1-R6) and families, facility in house doctor and obtained copy of physician communication report.

The investigation revealed of the following: In regards to the allegation of "Resident has severe case of scabies" LPA interviewed the facility regional nurse on 09/07/2022 and reported that residents were not diagnosed with scabies and residents only had suspicious rashes from July to August 2022. Medical treatment was sought for residents in question as required and the issue ~~was~~ had been resolved but residents were treated prophylactically as a preventive measure. LPA also reviewed the residents' physician communication report and indicated for rashes and itching. LPA contacted the medical professional on 11/18/2022 and it was confirmed the facility did have scabies infection about two to three months ago (July to September 2022). The medical professional reported he did not remember how many residents got infected but for sure it’s more than two residents. Affected residents were treated and the issue was resolved. In regards to Resident #1, she was admitted to the hospital on 09/01/2022 and diagnosed with an advanced case of scabies which had not been properly treated and/or required medical treatment had not been obtained per emergency personnel. R1 did not get proper treatment at the facility while the facility had a scabies outbreak.

Based on LPA’s observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to the Wellness Director Yumi Ludwig along with the Appeals Rights.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220902163645

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/04/2023 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.	1 2 3 4 5 6 7	Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date
	8 9 10 11 12 13 14	The requirement was not met as evidenced by interviews conducted and records reviewed which indicated the facility failed to obtain additional medical care for R1 as required which resulted in the advancement of her scabies diagnosis which posed a potential risk tor resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

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