198603535-8-29-2024-28-AS-RORN-D9MUXZ-20241001155906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:14:49 PM

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
08/27/2024 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20240827135724

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: 147	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	12:12 PM
MET WITH:	Maya Mnoyan, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not ensure infection control guidelines are being followed
Staff do not ensure changes in residents health conditions are being monitored

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted an unannounced initial 10 day complaint visit regarding the above allegations. LPA met Maya Mnoyan (Administrator) and explained the reason for the visit.

During today's visit, LPA reviewed and obtained client and staff roster, client admissions agreement, face sheet, physician order. LPA toured the physical plant with Administrator Mnoyan and did not observe any deficiencies or health and safety concerns. LPA Vaid interviewed Staff 1-6 (S1-S6). LPA interviewed residents 1-14(R1-R14).

Regarding the allegation: Staff do not ensure infection control guidelines are being followed. It is alleged the facility staff are not following the infection control guidelines. Six (6) out of (6) staff deny the allegation. Fourteen (14) out of (14) residents interviewed could not corroborate this allegation. LPA reviewed the facilities Infection Control plan.
...... CONTINUED ON 809 C.........

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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-20240827135724

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: 08/29/2024

NARRATIVE

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Last reviewed and updated by Administrator on 03/28/24. LPA observed the staff using PPE’s through out the facility, no reported cases of COVID-19 at the facility. Based on documents reviewed, observations made, and interviews conducted. 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 allegation is UNSUBSTANTIATED.

Regarding the allegation: Staff do not ensure changes in residents health conditions are being monitored. It is alleged that the facility is not monitoring the residents’ health conditions. Six (6) out of (6) staff interviewed deny this allegation. Fourteen (14) out of (14) residents could not corroborate the allegation. The residents who are with serious medical issues are monitored every two hours, some residents are monitored every hour depending upon their medical conditions. Caregivers and med-techs communicated with one another via communication logs, to alert the next shift caregivers and med-techs of any medical issues, residents are experiencing and level of monitoring that needs to be administered. There have not been any reported, no serious incident reports(SIR) of residents hospitalized for excessive cough have been filed. Based on documents reviewed, observations made, and interviews conducted. 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 allegation is UNSUBSTANTIATED.

An exit interview was conducted and copy of this report was left with the Administrator, Maya Mnoyan.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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