198603535-7-30-2024-28-AS-RORN-D8JP22-20240827105509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/30/2024
Date Signed: 07/30/2024 11:53:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/25/2024 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20240725105346

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: 145	DATE:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Business Officer, Alyssa Morales		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee did not provide responsible party with a refund

INVESTIGATION FINDINGS:

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On 07/30/24 at 08:45 a.m., Licensing Program Analyst (LPA) S Vaid conducted an ten day unannounced complaint visit to the facility. Upon arrival LPA met with Alyssa Morales (Business Officer) and explained the purpose of the visit. Maya Mnoyan(Administrator) arrived shortly after.
During today’s visit LPA obtained resident/ staff roster, admissions agreement, physicians report, facesheet and email correspondence showing responsible party’s email with facility officers. LPA also interviewed administrator Maya Mnoyan. Toured the physical plant with the Administrator and did not observe any health and safety concerns.

Based on interviews conducted and documents reviewed the findings indicate the facility was notified on 04/13/24 by the responsible party the belongings of R1 were being moved to the rehab center where R1 would be residing for the remainder of their rehabilitation after being discharged from the hospital. Continued on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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-20240725105346

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
	VISIT DATE: 07/30/2024

NARRATIVE

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On 04/16/24 R1 passed away at the hospital, on 04/17/24 responsible party notified the administrator via email correspondence to start the prorated refund. 7 out of 7 residents were not aware of the refund process. 5 out of 5 staff interviewed denied the allegation. The administrator notified the responsible party the refund needed to go thru the corporate office, the corporate office would close out all outstanding accounts and the refund would be sent directly to the responsible party. On 07/14/24 the Business Office Manager informed the responsible party that the corporate office had completed the refund request and will be mailing the prorated refund. On 07/26/24, check in the amount of $699.07 was sent to the responsible party via USPS mail. The process for refunds depends upon corporates Accounts Payable department and their due diligence by Social Security and insurance payments according to the business officer.

Based on interviews conducted and documents obtained, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with Administrator Maya Mnoyan and copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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