198603535-2-22-2023-28-AS-RORN-CPQNQV-20230308094034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 02/22/2023
Date Signed: 02/22/2023 02:13:34 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
02/15/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230215160926

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: 63	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maya Mnoyan – Administrator		TIME COMPLETED:	02:28 PM

ALLEGATION(S):

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Staff does not safe guard resident's personal items.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Maya Mnoyan (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the resident and staff rosters, interviewed Administrator, Staff 1 - Staff 2 (S1 – S2), Resident 1 - Resident 7 (R1 – R7), R1's Family Member and R1's Power of Attorney (POA). LPA also toured R1's room and reviewed R1's file.

The investigation revealed the following: regarding the allegation "staff does not safe guard resident's personal items”, it is alleged that R1's personal belongings had been stolen. The following belongings were allegedly stolen: 4 watches, a bag of about 15-20 pairs of earrings, sunglasses and water bottle.

(Continued to LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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-20230215160926

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: 02/22/2023

NARRATIVE

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Administrator and staff interviewed stated that R1 did report these items missing, however, when R1 moved in R1 threw a lot of personal belongings to the trash. One of the staff took a bag of jewelry out of the trash, but R1 told the staff it was trash, therefore the staff gave it to the administrator to store just in case. They also stated that R1 refused to file a police report. Administrator stated that R1 found some of the earrings in the bag of jewelry that was recovered from the trash and she assisted R1 in searching R1's entire room for the other items, but could not find them. R1, R1's family member, and R1's power of attorney confirmed that R1 did threw things away when R1 moved in, but claimed that the items reported missing were not things that were thrown away. It was confirmed that R1 did refuse to file a police report. Interviewed with R1 revealed that these items went missing on different dates: sunglasses went missing on 12/03/2022, earrings went missing on 01/02/2023, the 4 watches went missing on 02/02/2023, and the water bottle went missing on 02/11/2023. However, R1 did not report these items missing to the facility until 02/13/2023. Residents interviewed revealed that 5 out of the 7 residents could not corroborate with the 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.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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