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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 09/22/2023
Date Signed: 09/22/2023 03:36:16 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
08/01/2022 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220801102037
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: 118DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Tyrese Robinson - ReceptionistTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility did not seek resident timely medical attention.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegation listed above. LPA met with the Tyreese Robinson the receptionst of the facility and explainedt the reason of the visit. Assistant Administrator William Woods and Administrator Maya Mnoyan arrived shortly thereafter.

The investigation consisted of the following: during the initial visit conducted on 08/05/2022, LPA Alberto Lopez interviewed three (3) Staff Members and also obtained Resident #1's (R1's) file, including R1's FACE Sheet, Physician Report, Emergency contacts, appraisal Needs and Services Plan, and incident reports.During today's visit, LPA Zaragoza reviewed these documents and also obtained an updated Staff and Resident Roster list, along with a Physician's Report for R1. LPA Zaragoza also interviewed S1 - S7, and also Residents #2 - 12 (R2 - R12). LPA attempted to interview R1, however R1 no longer lives in the facility.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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 5
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
08/01/2022 and conducted by Evaluator Erik Zaragoza
COMPLAINT CONTROL NUMBER: 28-AS-20220801102037

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: 118DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Tyrese Robinson - ReceptionistTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Facility did not ensure that resident was adequately fed while in care.
Facility did not ensure that resident was adequately hydrated while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with the Tyreese Robinson the receptionst of the facility and explainedt the reason of the visit. Assistant Administrator William Wood and Administrator Maya Mnoyan arrived shortly thereafter.

The investigation consisted of the following: during the initial visit conducted on 08/05/2022, LPA Alberto Lopez interviewed three (3) Staff Members and also obtained Resident #1's (R1's) file, including R1's FACE Sheet, Physician Report, Emergency contacts, appraisal Needs and Services Plan, and incident reports.During today's visit, LPA Zaragoza reviewed these documents and also obtained an updated Staff and Resident Roster list, along with a Physician's Report for R1. LPA Zaragoza also interviewed S1 - S7, and also Residents #2 - 12 (R2 - R12). LPA attempted to interview R1, however R1 no longer lives in the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20220801102037
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: 09/22/2023
NARRATIVE
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The investigation revealed the following: in regards to the allegation "Facility did not ensure that resident was adequately fed while in care", it is alleged that the resident had stopped eating and lost a lot of weight which led her family to call an ambulance to take her to a hospital over fears of malnutrition. During interviews with the residents, none of them corroborated the allegation that the facility does not ensure they are adequately fed. All of them indicated that they offer breakfast, lunch, dinner, and snacks to all the residents, and R8 indicated that they also accommodate her vegetarian diet as well and therefore believes they offer a good variety of food as well. During interviews with the staff members, none of them corroborated the allegation that residents are not adequately fed while in care. All staff explained that residents are fed breakfast lunch and dinner at the facility, and S2 along with S6 explained that if a resident is determined to be failing in death due to no longer eating, then they immediately report the issue to the resident's physician for further guidance.

In regards to the allegation "Facility did not ensure that resident was adequately hydrated while in care", it is alleged that once R1 was admitted into the hospital, it was determined by the doctors at the hospital through testing that the resident was suffering from extreme dehydration along with malnutrition. During interviews with the residents, none of them corroborated the allegation that residents are not adequately hydrated while in care. All residents interviewed indicated that water and juice is available for them at all hours of the day whenever they ask for it. During interviews with the residents, none of them corroborated the allegation that they do not ensure that residents are adequately hydrated. They all explained that water and juice is provided to the residents every day, and S4 explained that if a resident is displaying signs of failing to hydrate themselves, the facility makes sure to elevate the situation to the Med Techs and the resident's physician to determine the next course of action.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations 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 above allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20220801102037
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: 09/22/2023
NARRATIVE
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Regarding the allegation "Facility did not seek resident timely medical attention", it is alleged that R1's deteriorating health condition due to malnutrition and dehydration was not properly addressed by the staff of the facility, which forced her family to call an ambulance to take her to a local hospital. During interviews with the residents, seven (7) out of eleven (11) residents interviewed corroborated the allegation that they have not received appointments with doctors and specialists after they have asked for assistance in scheduling appointments, others have said delays in receiving medical care have forced them to admit themselves to the emergency room, and others explain that they are still waiting for medical care as they have not received a full physical since being admitted to the facility despite having health concerns. During interviews with the staff, none of them corroborated the allegation that the facility does not seek timely medical attention for the residents, however S6 did explain that R1 did not want to eat during their quarantine due to COVID and it was perhaps overlooked that R1's condition may have been declining at this time and did not seek medical attention for R1. The facility initially notified R1's family of the facility's concern that R1 had not been eating on 7/26/2022, and this report along with the family's concern that they had not had contact with R1 in the recent days led the family to call an ambulance and paramedics to take R1 to the hospital on 7/31/2022. R1 did not return to the facility after this hospitalization.

Based on LPAs interviews conducted with the residents and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the administrator Logan Harrison.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20220801102037
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: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2023
Section Cited
CCR
87468.1(a)(16)
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87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services.

This requirement is not met evidenced by:
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Administrator shall ensure that all residents are afforded timely medical care. Administrator is to submit a written plan indicating how the facility will meet regulation 87468.1(a)(16) in a timely manner for all residents moving forward.
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Based on interviews, LPA determined that facility staff noticed R1's health was declining on 7/26/2022, however medical care was not obtained until 7/31/2022 after R1's family called for an ambulance, which poses an immediate health and safety risk.
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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 SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5