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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 08/25/2023
Date Signed: 08/25/2023 03:07:16 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
08/16/2023 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230816101140
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:DEOSO, GEMMAFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 119DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Maya MnoyanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is not providing residents with keys to lock bedroom door.
Facility is not serving meals in a timely manner.
Food being served is of poor quality.
Staff do not prohibit resident from harassing other residents.
Staff allow residents use illegal drugs and drink alcohol in the facility.
Facility staff is not ordering resident medication on time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint investigation visit to deliver findings on 08/25/23 regarding the above allegation(s). LPA Ramirez was met by Staff #1(S1) and explained the purpose of the visit.

The investigation consisted of the following: Initial complaint investigation was conducted on 8/22/23 by LPA Ramirez. LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Resident Roster (LIC 9020), Staff #1 - 4 interviews (S1 – S4), Resident #1-4 interviews (R1 – R4), copies of Resident #2 (R2): current Physician’s Orders as of 8/22/23, Physician Visit dated 7/27/23, Physician Visit dated 6/15/23, Acknowledgement of receipt of room key, and physical plant tour.

See 9099-C for continuation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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-20230816101140
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: 08/25/2023
NARRATIVE
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The investigation revealed the following. Regarding Allegation(s): Facility is not providing residents with keys to lock bedroom door. It is alleged the facility is not providing residents with keys to lock their accommodations due to the locks being in disrepair. On 7/17/23, LPA Ramirez, cited facility for not providing at least seven (7) residents with keys to lock their accommodation. The facility did not provide keys due to the facility locks being in disrepair. Plan of correction (POC) was submitted on 7/25/23 for deficiency. Although the facility submitted POC, it was noted that additional parts would be required to repair or replace some locks and the locksmith would return and repair or replace the locks. On 08/22/23, LPA Ramirez observed locksmith replacing and repairing locks to resident accommodations. As of 8/22/23, Administrator Mnoyan revealed most locks have been rekeyed and all residents that requested a key received a key and signed an acknowledgment of receiving key. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Facility is not serving meals in a timely manner. It is alleged that kitchen servers are taking thirty (30) minutes to bring out meals during dinning hours. Three (3) out of the four (4) residents interviewed deny this allegation. Four (4) out of the four (4) staff interviewed deny this allegation. Interviews with staff revealed that although the dinning room is open at 7:30 am, residents can arrive early and wait for their breakfast to be served. According to staff, residents that arrive early before meals times are served, may feel like their meals are taking longer than usual. Staff revealed to that most meals are brought out within 10 minutes of placing order. LPA Ramirez toured kitchen and dining room area during breakfast and lunch. At 11:41 am LPA Ramirez observed staff serving meals within 8 minutes at 1 table with 2 residents during lunch. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Food being served is of poor quality. It is alleged the facility is serving poor quality foods to residents in care. On 8/22/23, LPA Ramirez observed kitchen area and dinning room during breakfast and lunch hours. LPA Ramirez observed facility walk in refrigerator thermostat to read 39 degrees F. LPA Ramirez observed perishable food inside walk in refrigerator to be sealed in containers. LPA Ramirez did not observe any deficiencies. Containers were labeled with date of expiration. LPA Ramirez observed facility cook heating spiral cut ham for lunch. Three (3) out of the four (4) residents interviewed deny this allegation. Four (4) out of the four (4) staff interviewed deny this allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

See 9099-C for continuation.

SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230816101140
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: 08/25/2023
NARRATIVE
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Staff do not prohibit resident from harassing other residents. It is alleged facility staff do not stop resident from harassing another resident. Three (3) out of the four (4) residents interviewed deny this allegation. Four (4) out of the four (4) staff interviewed deny this allegation. Three (3) of the residents interviewed revealed R5 will repeatedly ask residents and staff for cigarettes. Three (3) out of the four (4) residents interviewed reported R5 is annoying but not harassing or violent. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Staff allow residents use illegal drugs and drink alcohol in the facility. It is alleged facility staff allow residents to use illegal drugs and drink alcohol in the facility. Three (3) out of the four (4) residents interviewed deny this allegation. Four (4) out of the four (4) staff interviewed deny this allegation. LPA Ramirez toured four (4) resident accommodations. No health and safety risks were observed. Residents interviewed revealed that although they have never seen illegal drugs being used in the facility, they believe other residents go out of the facility and return intoxicated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Facility staff is not ordering resident medication on time. It is alleged that the facility is not ordering residents medications on time. Three (3) out of the four (4) residents interviewed deny this allegation. Four (4) out of the four (4) staff interviewed deny this allegation. LPA Ramirez reviewed R2’s medication record and medical file. Records review revealed that on 06/15/23, R2 saw their physician and the physician ordered 30 tablets of a pain reliever. However, once the order was received and processed by the pharmacy, the physician changed the prescription to the pharmacy and decreased the number of pills to fourteen (14). LPA Ramirez reviewed original prescription request for 30 tablets of pain medication on 6/15/23 and electronically revised prescription for 14 tablets that was sent to the pharmacy on 6/16/23. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Administrator Mnoyan. A copy of this report was provided.

SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3