198603535-10-26-2023-28-AS-LHIS-CYJLV5-20231215080457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/26/2023
Date Signed: 10/26/2023 04:20:15 PM

Unsubstantiated

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
10/20/2023 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231020154831

FACILITY NAME:	SANTA ANITA ASSISTED LIVING		FACILITY NUMBER:	198603535
ADMINISTRATOR:	MAYA S MNOYAN		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVENUE		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	150	CENSUS:	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maya Mnoyan		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Illegal eviction
Facility is retaliating against resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Executive Director Maya Mnoyan and Administrative assistant William Woods to discuss the purpose for todays visit.

LPA toured the front of the facility, interviewed the Executive Assistant, staff #1-#2, interview residents, and requested a copy of the staff roster, resident roster, face sheets and eviction notices issued within the last 30 days.

Regarding allegation: illegal eviction. There were roomers that resident #1 and resident #2 were selling drugs, but the administrator has no evidence. She said she called the Temple City Police Special assignment deputy's but they wouldn't go inside resident #1 and resident #2's room without them being present. Residents who were interviewed 1 out of 3 said they had knowledge resident #1 selling drugs in the facilty,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20231020154831

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
	VISIT DATE: 10/26/2023

NARRATIVE

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but no proof was provided. On September 19, 2023, Executive Director Maya Mnoyan issued a 30 day eviction to the resident based on hearsay of other residents. On October 17, 2023, LPA Kimberly Ramirez requested that the Executive Director Maya Mnoyan rescind the 30 day notice for resident #1 and the Executive Director rescinded the 30 day notice on October 25, 2023. LPA Wesley was unable to interview resident 1 because they are not in the facility and based on the text conversation from the resident, they will not be returning.

Regarding allegation: Facility is retaliating against resident. Based on the pictures provided the condition that resident #1 room was altered, the sprinklers, the call box was not working, the closet doors contained graffiti on them, and the room was thrashed. When the resident came back to the facility after being gone for a number of days, the administrator place her in room 122 which was a better kept room and the resident had a roommate that she got along with. There was no reason for resident to feel that she wasn't issued the same room because she contacted Community Care Licensing Division, as she was given the room assignment prior to her contacting Community Care Licensing Division as the room she was in was altered and there was no way of the resident using the call button and the sprinklers in her room were not operable.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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