198603535-7-21-2022-28-AS-RORN-CJAN2F-20220915100440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/21/2022
Date Signed: 07/21/2022 02:22:29 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
07/06/2022 and conducted by Evaluator Joe Katrdzhyan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220706082808

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: 57	DATE:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator / Sabina Nayberg		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are not properly supervising residents in care.

Resident's bedroom waste basket is not being emptied as often as needed.

Resident's bedroom is malodorous.

Facility meals are not of the quality or quantity necessary to meet the needs of the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced follow up visit to this facility to deliver findings on the above mentioned allegations of "Staff are not properly supervising residents in care, Resident's bedroom waste basket is not being emptied as often as needed, Resident's bedroom is malodorous and Facility meals are not of the quality or quantity necessary to meet the needs of the residents."
Upon arriving at the facility, LPA met with Administrator / Sabina Nayberg who assisted with the visit.

LPA Katrdzhyan conducted a prior visit to this facility on 7/14/22, in reference to the allegations listed above. The investigation consisted of interviews of various persons to include the Administrator, Staff members 1 through 3 (S1 - S3) and Residents 1 through 5 (R1 - R5). LPA toured a random selection of resident rooms, toured the facility kitchen and dining room. Also, a copy of the facility food menu for the month was obtained.

Please see LIC 9099C for additional information.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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-20220706082808

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: 07/21/2022

NARRATIVE

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The investigation revealed the following;

Allegation: Staff are not properly supervising residents in care. The details of this allegation states that one night (date unknown) around 8 or 9pm, an unknown female resident needed assistance because she was found lying on the floor. At the time, there was no staff available to help.
Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegation. Staff and residents interviewed denied facility having insufficient staff to meet the needs of residents. Interviews conducted of staff determined that during the morning shift (6am – 2pm), there are usually 3 caregivers and 1 med tech on duty. During the afternoon shift (2am – 10pm), there are 2 -3 caregivers and 1 med tech on duty. During the knock shift (10pm – 7am), there are usually 2 caregivers and 1 med tech on duty. According to the Administrator staffing has been a struggle with Covid and it may vary day to day but there is always sufficient number of staff to meet the needs of residents. Based on interviews conducted, there is insufficient evidence to support this allegation to be true.

Allegation: Resident's bedroom waste basket is not being emptied as often as needed and Resident's bedroom is malodorous. The details of these allegations state that adult diapers are thrown away in the bedroom waste basket and facility staff does not empty the waste basket often enough which causes resident rooms to smell bad.
Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegations. Staff and residents interviewed stated that the waste baskets are emptied in resident rooms daily. Staff denied throwing away adult diapers in resident rooms causing resident rooms to smell malodorous. Residents interviewed denied their rooms smelling bad as a result of staff not emptying their waste baskets. During the visit conducted on 7/14/22, LPA toured a random selection of resident rooms (106, 143, 164, 171, 175, 178, 180, 183, 187, 131, 133 and 124) and the waste baskets in residents rooms were observed to be empty. Some of the rooms toured happened to be of residents with incontinent issues and during the walk through, there was no malodorous smell present in resident rooms and resident rooms were observed to be clean and sanitary. Based on interviews conducted and LPA's observation, there is insufficient evidence to support this allegation to be true.

Allegation: Facility meals are not of the quality or quantity necessary to meet the needs of the residents. The details of this allegation states that food served to the residents at this facility is really poor quality and not enough (only one chicken leg and one scoop of rice or a hot dog and juice being served for dinner).

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220706082808

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: 07/21/2022

NARRATIVE

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Based on interviews conducted, the statements obtained were inconsistent and did not corroborated with the allegation. Staff and residents interviewed denied the food not being of good quality or quantity to meet the needs of residents. Staff and residents stated that the meals served during breakfast, lunch and dinner are of variety and residents get additional or seconds upon request. LPA verified on the facility food menu that the meals served daily are not the same and there is a variety during each serving. According to the Administrator, everything listed on the menu is approved by a dietician. In the event, a resident refuses to eat what is listed on the daily menu, there is a substitute which consists of a "Ham & Cheese Sandwich, Peanut Butter Jelly Sandwich, Grilled Cheese, Tuna Sandwich and Egg Salad". During the visit conducted on 7/14/22, LPA toured the facility kitchen and observed an ample supply of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed meats, fruits, vegetables, eggs, juice, milk and snacks at the facility. Based on interviews conducted, LPA's observation and record review, there is insufficient evidence to support this allegation to be true.

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 allegations are Unsubstantiated.

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

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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