198603535-5-14-2024-28-AS-FFIS-D73UV6-20240711155436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:00:42 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
09/22/2023 and conducted by Evaluator Valeria Maldonado

COMPLAINT CONTROL NUMBER: 28-AS-20230922131350

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: 140	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alyssa Morales- Business Office Manager		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff allow residents to use illegal drugs in the facility.
Staff sell illegal drugs to residents in care.
Staff do not ensure that the facility is clean.
Staff do not ensure that resident is provided transportation to medical appointments.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced subsequent visit to the facility for the purpose of contiunuing the investigation of the above-allegations. LPA met with Business Office Manager, Alyssa Morales, and explained the purpose for the visit. Administrator Maya Mnoyan arrived shortly after to assist with the visit

On 09/25/23, LPA Maldonado conducted an initial visit to the facility. The visit consisted of the following: LPA obtained a copy of resident/staff rosters, conducted a tour of physical plant and common areas with Administrator, Maya, and obtained the following documents for Residents# 1-4 (R1-R4): Facesheet, Physician's Report, Pre-Placement Appraisal, and Needs and Services Plan. LPA observed food supplies and random resident rooms. The residents were also observed to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns during today's visit.
(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: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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 4

Control Number 28-AS-20230922131350

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: 05/14/2024

NARRATIVE

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The following allegation: Staff sell illegal drugs to residents in care, was investigated by the Department.

The departments investigation consisted of the following: Interviews conducted with Staff#1-9 (S1-S9), Resident#1 (R1), Residents#5-10 (R5-R10), and Former Resident#1 (FR1). IB also obtained records from R5-R11's files, facility incident reports, Charting notes, SOC341 records completed by the facility, and documented staff encounters to incidents of possible drug use by residents. The investigation revealed the following:

Regarding allegation: Staff sell illegal drugs to residents in care.
It is alleged that residents are buying illegal drugs, such as methamphetamines, from S1. Per IB's interviews conducted with staff, (9) of (9) staff denied selling illegal drugs, including methamphetamines, to residents. Staff stated to have witnessed some residents showing signs of being under the influence of methamphetamines (staring off, talking to themselves, and dilated pupils). Staff also stated that S2 met with the suspected dealer, R1, to stop selling at the facility. Facility was unable to evict R1 due to lack of evidence to formally evict R1. Per S2, facility staff were instructed to notify S2 and document any suspicious activity on facility grounds. Incident Reports obtained by IB reflected the facility has reported these incidents to the licensing agency. The incident reports documented residents reporting to staff that R1 was selling drugs to other residents. SOC341's were also completed and incidents were reported directly to law enforcement, by the facility. Per the interview conducted with S1, S1 denied ever being in possession of any drugs or selling them to residents at the facility. Per interview with R1, R1 denied S1 to have sold methamphetamine's to R1 or other residents. R1 also denied selling drugs to residents. Therefore, this allegation is Unsubstantiated.

During today's visit, LPA Maldonado, continued the investigation regarding the following allegations:

Staff allow residents to use illegal drugs in the facility.
Staff do not ensure that the facility is clean.
Staff do not ensure that resident is provided transportation to medical appointments.

LPA obtained a copy of the resident and staff rosters and a copy of Admission's Agreement for R1. LPA also conducted interviews with Staff#2-5 (S2-S5), Staff#10-11 (S10-11), Residents#1-2 (R1-R2), and Residents #11-14 (R11-R14). The laundry room/services were also inspected and observed.

The investigation revealed the following:
(Report Continued on LIC9099-C...)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20230922131350

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: 05/14/2024

NARRATIVE

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Regarding allegation: Staff allow residents to use illegal drugs in the facility.
It is alleged that several residents at the facility were using methamphetamine with staff and Administrator knowledge, and allowed it. Per staff interviews, (6) of (6) staff denied allowing residents to use illegal substances on facility premises. Staff stated that any suspicious activity observed that may depict residents using illegal substances or being under the influence are to be reported to the Administrator immediately and to document the observation. Per resident interviews, (5) of (6) residents denied the allegation. Residents stated using illegal drugs/substances is prohibited as part of the house rules and staff do not allow it. If staff believed someone was under the influence, law enforcement is called. Per SOC341's obtained by IB, it was documented that the facility reported the incidents directly to law enforcement. Incident reports also obtained by IB indicate that the facility documented and reported known incidents of residents observed under the influence of illegal substances. Therefore this allegation is Unsubstantiated.

Regarding allegation: Staff do not ensure that the facility is clean.
It is alleged that facility staff do not wash resident's bedding and do not vacuum. Upon entry to the facility, LPA Maldonado observed (3) different housekeeping staff pushing carts with clean and folded linens, taking out trash from resident rooms, and sweeping and mopping resident rooms and hallways. During resident interviews, LPA observed housekeepers exiting rooms 119 with trash, observed the laundry room to be operating and fully stocked with clean folded clothes. LPA observed laundry staff delivering clean clothes on a hangar to room#145. The facility was free from odors and appeared to be clean and sanitary. Per staff interviews, (6) of (6) staff denied the allegation. Staff stated that housekeeping staff is on facility grounds (7) days a week and regularly clean resident rooms. Per S10, housekeeping change linens (2) to (3) times a week and as needed, laundry for all residents is done daily, and resident rooms are vacuumed once a week, unless a resident refuses housekeeping services on a certain day. Per resident interviews, (5) of (6) residents denied the allegation. Residents stated their rooms are cleaned daily, laundry is done daily and as needed, sheets are changed often and as needed, and rooms are vacuumed.

Regarding allegation: Staff do not ensure that resident is provided transportation to medical appointments.
It is alleged that facility staff are not assisting with taking R1 to R1's medical appointments due to being too far, although they are taking other residents to appointments that are further. Per staff interviews, (6) of (6) staff denied the allegation. Staff stated that S4 and S5 assist residents with making medical appointments when needed, and the receptionist will schedule the transportation for the medical appointments via the facility vehicle or a company contracted service.
(Report continued on LIC9099-C...)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230922131350

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: 05/14/2024

NARRATIVE

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Residents also have the option of requesting transportation services provided through their insurance. Staff also stated that if a resident's appointment is far, they will assist with finding a physician closer to the area, if the resident chooses. Per R1, R1 has been taken to medical appointments before by the facility van. However, they facility did not want to give R1 a ride to the liquor store and R1 had to pay for a taxi to take R1. (6) of (6) residents interviewed denied the allegation. Per interview with R13, R13's medical appointments are far and facility staff accommodate R13 to get R13 to their medical appointments.

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.

Per California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit.

An exit interview was conducted with Administrator, Maya Mnoyan, 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: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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