198603535-1-29-2024-28-AS-FFIS-D292DM-20240207161835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 01/29/2024
Date Signed: 01/29/2024 12:02:14 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
01/23/2024 and conducted by Evaluator Valeria Maldonado

COMPLAINT CONTROL NUMBER: 28-AS-20240123134117

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: 128	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	William Woods- Administrative Assistant		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not provide adequate food service for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced complaint visit to the facility for the purpose of investigating the above-mentioned allegation. LPA Maldonado met with Administrative Assistant, William Woods, and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the resident and staff rosters, a copy of the food menu, conducted a tour of the physical plant with special focus on the kitchen and food services, and obtained the Facesheets and Physician's Reports for Residents# 1-8 (R1-R8). LPA also conducted interviews with Staff# 1-5 (S1-S5) and R1-R8.

The investigation revealed the following:

(Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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-20240123134117

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: 01/29/2024

NARRATIVE

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Regarding allegation: Staff did not provide adequate food service for resident.
It is alleged that on 1/23/24, a resident was denied breakfast upon their return from a medical appointment, due to them being out of the facility during the meal time, although they were promised breakfast upon their return. Per interviews conducted, (5) of (8) residents denied the allegation. Residents stated that snacks are provided to take with them to their appointments, and a meal is provided upon their return. Residents also stated that they have not had any issues with receiving a meal upon their return from their appointments. (2) of (8) residents interviewed could not corroborate the allegation as they stated they do not leave for regular medical appointments. (5) of (5) staff interviewed denied the allegation. They stated that it is the facility's policy to hold a meal for the residents any time they are out for a medical appointment. And if the meal is not held, the kitchen staff will personally prepare a fresh meal for the resident upon their return the facility. Staff state to be unaware of any resident being denied a meal upon their return from their medical appointment in the last 2 weeks.

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.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

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