198603535-5-8-2025-28-AS-FFIS-DHHV48-20250610160552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 04/07/2025
Date Signed: 05/08/2025 09:09:20 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
12/30/2024 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241230090004

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: 149	DATE:	04/07/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Ruth Villa-Welness Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee did not provide notice of rate increase to residents in care.
Staff did not dispense medications as prescribed.
Staff do not ensure residents medications are properly managed.
Staff do not ensure residents are treated with dignity and respect by others residents in the facility.
Staff did not ensure residents personal belongings were kept safely secured.
Staff did not provide resident with copy of requested records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S Vaid conducted a subsequent complaint visit today regarding the listed allegations and to deliver complaint investigation findings. Met with Ruth Villa, Wellness Director and explained purpose of the visit. LPA Vaid and Wellnesses Director toured the facility and di not observe any health and safety concerns.

The investigation conducted on 01/06/25, consisted of the following: LPA toured the physical plant. LPA Interviewed staff 1-7 (S1-S7) and clients 1-14 (C1-C14). LPA requested, collected, and reviewed documents from C1's face sheet, physicians reports, service plan, needs and services, medication file, and copies of six (6) random clients: face sheet, medication list, written physicians’ orders, physician reports. Facility Plan of Operations regarding controlled substance management, copy of posted flyer for pharmacy change, letter sent to SSI recipients regarding rate increase.

Continued on 9099C.....

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

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 6

Control Number 28-AS-20241230090004

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: 04/07/2025

NARRATIVE

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Regarding the allegation: Licensee did not provide notice of rate increase to clients in care. It is alleged that facility owners increased the monthly rent on all the clients without proper notification. Seven (7) out of seven (7) staff deny this allegation. According to business office staff, increase in the rental room rate is increased per year, as per Admissions Agreement. Notice of increase is communicated by letter to the residents’ and their POA. Higher needs and services require skilled nursing. Notice of new room rate increase and personal needs allowance was communicated to all the residents. According to the business office staff and records residents who were assessed by August Health(third party health point system) and determined an increased/decreased in level of care, was communicated to the residents and their POAs, by the business office staff. Resident was at Level 2 from January 2024 thru October 2024. Resident was reassessed by August Health in October 2024 to level 1, decreasing the monthly care rate. Statement of notice was delivered to Resident, by business office staff. Records for October 2024 thru January 2025 shows rent increase and level of care rate decreased. Resident has been paying 2024 rent rates for the year 2025 and thus is behind in rental payments. The business office is attempting to work with resident to collect the balance. Thirteen (13) out of fourteen (14) residents interviewed could not corroborate the allegation. Interviews with residents reveals that rate increase occurs when care and need levels increase, when a resident is determined unable to perform self-ADL’s like continence care an increase occurs, and are informed by staff before charge is made to the clients account. Several residents stated, they have been notified by staff when an increase is made in their level of care and yearly rental increases. Several other residents stated they receive SSI (Social Security Income), and they were given statement of notice for the rate increase for new rooms and increase in monthly personal needs expenses, by the business office staff. Based on interviews conducted and records reviewed, there is insufficient evidence to support this allegation. 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.

Continued on 9099C......

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 28-AS-20241230090004

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: 04/07/2025

NARRATIVE

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Regarding the allegation: Staff did not dispense medications as prescribed. It is alleged that the medication technicians (Med-Techs) are not dispensing the correct medication to residents. Thirteen (13) out of fourteen (14) residents interviewed could not corroborate the allegation. Residents stated they are receiving their medications daily. Seven (7) out of seven (7) staff interviewed deny this allegation and stated that they have not observed the med-tech staff mismanaging the resident’s medication. The Med-techs interviewed, stated that medication is administered as prescribed by physician orders and logged into the Medication Administration Record. LPA's review of five (5) random residents medications, and medication administration records, observed that medication are administered by staff as prescribed. During the afternoon, LPA observed AM-shift med-techs performing medication count before the PM shift was assigned the mobile medication carts. The PM shift med-tech then also make a pill count before next round of late afternoon/evening medications administration. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegation. 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.

Regarding the allegation: Staff do not ensure residents medications are properly managed. It is alleged that Medications is not being ordered in timely manner causing medication shortages for the residents. Thirteen (13) out of fourteen (14) residents interviewed stated they have not had interruptions in medications they receive. New prescriptions are filled and started within a few days of the doctors’ visit. Seven (7) out of seven (7) staff interviewed deny this allegation. Med-techs interviewed stated, through the electronic medication management system, notification of low medication supply is electronically sent to the pharmacy who can restock the medications without interruptions for the residents. The med-techs works closely with the pharmacy to ensure medications re-ordered by the facility and new medication prescribed by the physicians are readily available to the residents. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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.
Continued on 9099C.....

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 28-AS-20241230090004

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: 04/07/2025

NARRATIVE

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Regarding the allegation: Staff do not ensure residents are treated with dignity and respect by other residents in the facility. It is alleged that facility staff is not ensuring that all residents get along with one another and that residents treat each other with dignity and respect. Seven (7) out of seven (7) staff interviewed deny this allegation. Staff stated they treat all the residents in their care with respect and dignity. Staff request all residents to treat each other with kindness and mutual respect. However, the staff cannot control the attitudes and views of all residents. Thirteen (13) out of fourteen (14) residents interviewed stated they get along with each other, sometimes there are disagreements between residents. One resident stated, sometimes residents have a heated exchange of words and sometimes gets loud, and fights break out, however, staff quickly intervene and redirect the residents. Another resident stated, people here don’t always get along, I don’t need to be nice and friendly to everyone, only civil. Based on interviews conducted there is insufficient evidence to support the allegations. 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.

There was a concern regarding a resident being harassed by another resident. It appears they had a personal relationship based on resident interviews. However, it could not be determined this was due to facility’s lack of supervision, based on interview with Administrator Joel Niblett. Resident was advised that the other resident has right to reside at the facility. Administrator advised both residents to respect each other’s right to privacy and keep distant from one another.

Continued on 9099C.....

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 28-AS-20241230090004

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: 04/07/2025

NARRATIVE

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Regarding the allegation: Staff did not ensure residents personal belongings were kept safely secured. It is alleged Staff are taking items from residents’ room while resident are not in resident’s room. Seven (7) out of seven (7) staff deny this allegation. The residents’ rooms are lockable and the keys for each room are assigned to resident(s) of the room. Staff keeps spare room key for housekeeping and emergencies to ensure residents safety when needed. Housekeeping cleans and sanitizes the rooms and have set time parameters for each room. Staff always ensures to remind residents to lock their rooms when leaving, even for a few minutes. Staff reported that R1 has a room and shares the room with another resident who also has a room key. Thirteen (13) out of fourteen (14) residents interviewed stated, the staff is respectful of their belongings, housekeeping helps to keep rooms clean. Resident reported, they have not had items missing from their rooms. One resident stated people are respectful of other resident’s personal property. Another resident stated, they keep their room keys with themselves whenever leaving the room and hope their roommates do the same. Another resident stated, keeps their belongings locked, because some people have greedy eyes. Interview with R1 revealed that R1 was unable to report what items were removed from R1 room and the investigation did reveal that items were removed from R1’s room or that staff do not safeguard resident belongings. Based on interviews conducted and observations made, there is insufficient evidence to support the allegations. 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.

Regarding the allegation: Staff did not provide resident with copy of requested records. It is alleged that the business office staff did not provide a resident with monthly rent records in a timely manner, however staff asked resident to pay rent based on the amount previously charged and staff would reconcile the payment at a later date. Seven (7) out of seven (7) staff interviewed deny this allegation. Business office staff stated computers were not operating the entire day for one day only due to telecommunications interruption and were up the next day. Requests for records are completed via written request from the residents stating: type of record(s), the date range of the request. Staff stated all requests are completed within 1-2 days.

Continued on 9099 C.......

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 28-AS-20241230090004

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: 04/07/2025

NARRATIVE

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A verbal request to staff requesting lengthy records is not permitted to ensure correct information is provided to the requestor. A written request such as a copy of vaccine record or copy of a medication list can be facilitated immediately. Thirteen (13) out of fourteen (14) residents interviewed were not able to corroborate this allegation. Residents interviewed stated their request for records is completed by staff in a reasonable amount of time. Other residents interviewed stated they have not had issues with requesting and receiving records and/or receive information within 2-3 days, depending upon the size of the request. Interview with R1 confirmed that staff provided R1 with the requested record in a timely manner. Based on interviews conducted and observations made, there is insufficient evidence to support the allegations. 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.

Exit interview was conducted and copy of this report was provided to Administrator Joel Niblett.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 6 of 6