198603535-7-25-2024-28-AS-FFIS-DAK2QT-20241030173627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:46:51 PM

Substantiated

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
07/22/2024 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20240722134903

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:	07/25/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Maya Mnoyan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) S Vaid conducted an unannounced 10 day complaint investigation visit for the allegation listed above. LPA met with Executive Director Maya Mnoyan to discuss the purpose for today’s visit.

LPA toured the facility, interviewed the Administrator, staff #2-#5, interview residents #1-#5, and requested a copy of the staff roster, resident roster, face sheet, admission agreement, physicians report, needs and services.

Regarding allegation: illegal eviction.
On 07/04/24 R1 was taken by paramedics to Arcadia USC due to shortness of breath, R1 was under the impression they would return to the facility upon being discharged from the hospital. On 07/05/24, facility administrator spoke to the Social Worker regarding R1 state of health and suggested that higher level of care was needed, both the social worker and facility administrator agreed. On 07/09/24, R1 family collected R1 personal belongings and medication for safe keeping, not knowing the protocols of the facility. CONTINUE ON 9099C...

Substantiated

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: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

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-20240722134903

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: 07/25/2024

NARRATIVE

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There was no exchange in communications by the family nor the facility on whether R1 would be returning. No notice was given by resident(R1) to the facility of their plans to leave the facility, as indicated in the admissions agreement a 30-day notice is expected by the facility for anyone moving out of the facility. The administrator is refusing to allow the resident back into the facility citing no beds available. The capacity of the facility is 150 beds and todays census is 146, therefore the facility has room for four more residents until full to capacity. Administrator stated that four beds were reserved for new residents, however the facility is taking new residents when exsisting residents are still admitted to facility. The facility is in direct violation of the admissions agreement. R1 is ready to be discharged from the hospital however facility does not have room available, R1 room was given to another resident.

Based on interviews, records reviewed and obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D.

En exit interview was conducted and a copy of this report was provided to the along with the appeals rights.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240722134903

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/25/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/25/2024 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	87224 Eviction Procedures...(a) The licensee may evict a resident.. Thirty (30) days written notice to the resident is required....	1 2 3 4 5 6 7	Within 24-48 hours facility will send nurse to hospital and perform an assesment and then R1 will continue residing at the facility until more skilled nursing home is found for the resident.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: The facility did not comply with regulation of evictions procedures. R1 is ready to be discharged from the hospital however facility does not have room available for R1, facility gave away room to other resident. R1 did not given 30 day notice to facility about leaving.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

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