198603535-7-21-2023-28-AS-TVAO-CULT5W-20230811142613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/21/2023
Date Signed: 07/21/2023 02:31:36 PM

Unsubstantiated

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
07/12/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230712154816

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: 112	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	William Woods and Maya Mnoyan		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not prevent residents from assaulting other residents in care
Staff not meeting Resident incontinent needs.
Staff do not provide proper shower assistance to residents in care
Facility is in disrepair
Facility is malodorous
Residents smoke inside the facility
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial visit to investigate the above allegations. LPA met with William Woods (Assistant Administrator) and discussed the purpose of today’s visit. Maya Mnoyan (Administrator) arrived at approximately 9:05 A.M..

During this investigation, LPA obtained a copy of the staff roster and resident roster, reviewed files for Resident #1 (R-1) through Resident #5 (R-5) and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Resident #1 (R-1) through Resident #10 (R-10) and conducted a facility tour.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
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)

Page: 1 of 4

Control Number 28-AS-20230712154816

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: 07/21/2023

NARRATIVE

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Allegation: Staff did not prevent residents from assaulting other residents in care. Per S-1 and S-2, on 05/24/23, R-1 and R-2 were involved in an altercation. Staff intervened and contacted the local police department for assistance. This incident was also reported to Community Care Licensing (CCL). As a result of this incident, both R-1 and R-2 are no longer sharing the same bedroom and R-1 returned back to R-1’s previous roommate (R-3). There has not been additional altercations between R-1 and R-2. Per R-1 and R-2, staff intervened and assisted in a timely manner. Per R-1 and R-2, there has not been additional incidents. Per R-1 and R-3 there has not been any altercations (including physical) with each other. Interviews do not corroborate this allegation.

Allegation: Staff not meeting Resident incontinent needs. Per Staff interviews, residents are not left in soiled diapers for several hours and do not wait until the next shift to complete this task. Staff interviews revealed that staff conduct rounds every (2) hours to assist Residents. Per staff interviews, rounds are documented on a log daily (including toileting/incontinence needs). Per Staff interviews, residents are not being double diapered and residents have not developed rashes as a result of incontinence care. Interviewed staff indicated they have not received any complaints/concerns in regards to staff not meeting residents incontinence needs. Resident interviews revealed that staff assist residents with incontinence care on a consistent basis. Per Resident interviews, staff conduct rounds every (2) hours and residents indicated they have not developed any rashes as a result of incontinence care. Interviews and documentation do not corroborate this allegation.

Allegation: Staff do not provide proper shower assistance to residents in care. Per Staff interviews, staff assist residents with showers. Interviewed staff indicated staff follow a “shower schedule” for residents. Staff interviews revealed that staff conduct rounds every (2) hours to assist Residents. Per staff interviews, rounds are documented on a log daily (including showering). Interviewed staff indicated they have not received any complaints/concerns in regards to staff not meeting residents showering needs nor reports of residents having bad body odor. Resident interviews revealed that staff assist residents with showers on a consistent basis. Per Resident interviews, staff conduct rounds every (2) hours and residents indicated they have not encountered anyone having bad body odor. Interviews and documentation do not corroborate this allegation.

Refer to LIC 9099 for the continuation of this report.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
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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Control Number 28-AS-20230712154816

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: 07/21/2023

NARRATIVE

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Allegation: Facility is in disrepair. (3) out of (4) staff interviews revealed that residents’ sinks are not broken. However, (3) out of (4) staff interviews indicated there was an incident on 06/22/23 at approximately 1:30 A.M regarding the bathroom sink inside room 181 (room vacant at the time of incident and continues to be vacant) leaking. This leak caused water to go into rooms 180 and 175. This incident was reported to S-1 and it was handled immediately. Rooms 181, 180 and 175 have flooring not carpet. Staff mopped and dried the flooring immediately following this incident with no issues noted. LPA conducted a tour of rooms 181, 180 and 175 and observed the rooms to have flooring not carpet and the sink in room 181 (handle) was replaced. Interviews and tour conducted do not corroborate this allegation.

Allegation: Facility is malodorous. Per staff interviews, resident rooms are cleaned daily and the facility does not have an odor of urine and/or feces. Interviewed staff indicated they have not received any complaints/concerns in regards to the facility being malodorous. Resident interviews revealed that the facility is kept clean at all times and that the facility does not have an odor of urine and/or feces. LPA toured facility grounds and did not smell an odor of urine and/or feces. Interviews and tour conducted do not corroborate this allegation.

Allegation: Residents smoke inside the facility. Staff interviews revealed the facility has designated smoking areas outside (courtyards) of this facility. (3) out of (4) interviewed staff indicated they have not witnessed nor have received any complaints from anyone in regards to smoking inside this facility. Per S-1, R-6 was recently caught smoking inside R-6’s room and S-1 immediately addressed this matter with R-6. S-1 indicated S-1 spoke to R-6 and reminded R-6 about the smoking policy. Per S-1, this was an isolated incident and has not reoccurred with R-6 nor has S-1 witnessed or received complaints/concerns from anyone in regards to residents smoking inside this facility. Resident interviews revealed they have not witnessed anyone smoking inside this facility.

Allegation: Staff did not safeguard resident's personal belongings. Staff interviews revealed that they have not received any concerns/complaints in regards to residents items going missing. Per staff interviews, Administrator has not indirectly accused staff of taking residents belongings. Interviewed staff indicated they are trained in Mandated Reporting and Resident Rights. Resident interviews revealed that they do not have items that have gone missing. Interviewed residents did not have any concerns in regards to facility not safeguarding their personal belongings. Interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
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)

Page: 3 of 4

Control Number 28-AS-20230712154816

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: 07/21/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on record review and interviews conducted the findings indicate, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED. An exit interview conducted, appeal rights and a copy of this report was provided to Maya Mnoyan.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
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)

Page: 4 of 4