198603535-7-6-2024-28-AS-TVAO-D6YQPS-20240708122109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/06/2024
Date Signed: 07/06/2024 01:28:10 PM

Unsubstantiated

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
06/10/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240610162952

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: 144	DATE:	07/06/2024
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Barbara Lopez-Care Coordinator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff does not meet residents grooming needs.
Staff don't answer facility phone.

INVESTIGATION FINDINGS:

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*This is a corrected version of previous report dated 6/14/24. LPA Ramirez corrected number of residents interviewed. LPA Ramirez met with Barbara Lopez and explained the purpose of the visit. LPA Ramirez redelivered this report on 7/6/24 with no changes to the findings.* Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 06/14/2024 regarding the above allegations. LPA Ramirez was met by Receptionist Tyryse Robinson. Administrator Maya Mnoyan, arrived shortly after to assist with tour.
The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 6 interviews (S1 – S6), Resident#1 – 10 (R1 – R10), copies of Resident#1 (R1)- Physician’s Report (LIC 602), Identification and Emergency Information form, Admission Agreement, Medication Administration Record (MAR), Facility resident progress notes, Caregiver assignment log for R1, and physical plant tour.

See 9099-C for continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2024

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-20240610162952

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: 07/06/2024

NARRATIVE

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The investigation revealed the following. Regarding Allegations: Facility staff does not meet residents grooming needs- It is alleged staff do not assist R1 with grooming. R1 arrived at the facility on 02/03/2023. Per R1’s Physician Report dated 3/4/24, R1 needs assistance with grooming. Six (6) out of the six (6) staff interviewed deny this allegation. Eight (8) out of the ten (10) residents interviewed deny this allegation. LPA Ramirez reviewed the facility Caregiver Assignment Logs for R1 which indicated R1 was assisted with grooming on different days R1 was present at the facility for the months of May and June 0f 2024. Staff interviews revealed R1 would leave the facility for days at a time. Staff revealed they would assist R1 with grooming when he returned. During facility tour and interviews with residents, LPA Ramirez observed residents to tidy in appearance. 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.

Staff don’t answer facility phone- It is alleged staff do not answer the facility phone when family members call the facility. On 6/12/ 2024, at 11:15 am, LPA Ramirez dialed facility phone number and was greeted by facility staff. On 6/13/2024, at 4:45 pm, LPA Ramirez dialed facility phone number and was greeted by facility staff. During facility tour, LPA Ramirez observed facility phone ringing and staff answering calls. Six (6) out of the six (6) staff interviewed deny this allegation. Nine (9) out of the ten (10) residents interviewed deny this allegation. 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.

No deficiencies were cited for this investigation complaint. Exit interview conducted with Administrator Mnoyan. A copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2024

LIC9099 (FAS) - (06/04)

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