198603535-10-11-2024-28-AS-FFIS-DDG3CM-20250131170805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/11/2024
Date Signed: 10/11/2024 03:01:26 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
08/15/2024 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20240815132940

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: 141	DATE:	10/11/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maya Mnoyan, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff are overdosing residents.
Staff are mismanaging resident's medications.
Staff are administering unprescribed medications to residents.
Staff do not answer residents’ call button in a timely manner.
Staff do not ensure residents’ showering needs are being met.
Staff do not ensure the facility has an adequate food supply.
Staff do not ensure residents attend scheduled medical appointments.
Staff do not ensure residents’ air conditioner is in good repair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S Vaid conducted a subsequent complaint visit regarding the above allegations. LPA conducted the initial complaint visit on 08/19/2024, this is a residential care facility for the elderly, a housing arrangement for persons, 60 years old and over. 24-hour non-medical care and supervision is provided. During today’s visit LPA met with Administrator Maya Mnoyan and explained the purpose of today’s visit. On today’s visit LPA Vaid conducted a physical plant tour with Admin Mnoyan and did not observe any health and safety concerns. Staff and home health agencies were observed assisting residents.

The investigation consisted of the following: LPA Vaid interviewed Administrator, staff, and residents and toured the physical plant with Administrator and observed staff assisting residents with ADL (assisted daily living). LPA Vaid interviewed Administrator, staff #S2-S14 and residents #R1-R15.
Continued on 9099C.....

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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 5

Control Number 28-AS-20240815132940

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: 10/11/2024

NARRATIVE

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LPA Vaid requested and obtained the following documents: Staff and resident rosters, maintenance log for A/C repairs and call box signal repairs and installation for 2024, five random residents EMARS and other pertinent documents regarding this investigation.

Regarding allegation: Staff are overdosing residents. It was alleged that staff are overmedicating residents with a Narcotic called Avitan used to treat adults with insomnia caused by anxiety and can cause drowsiness. Staff S1-S14 interviewed denied the allegation. Fourteen (14) out of fourteen (14) staff interviewed stated that they have not observed med-tech staff overmedicating any of the residents. The Med-techs have stated that the medication is administered as prescribed as needed. Each residents’ medication that is administered is logged into the MARs. The medication cart and the medication room is audited each month, by management. LPA's review of five (5) random residents’ medication, and medication administration records, observed medication to be administered as prescribed by physician’s orders. All medications are accounted, as shown in the MARs log, LPA performed pill count of medications in the bubble packs. LPA reviewed residents that are prescribed Avitan, the MARs indicate that the Avitan has been administered sparingly, administered when needed to specific residents with attributing health conditions. LPA did not perform pill count as the medication is bottled. Resident R1-R15 interviewed were unable to corroborate the allegation. Based upon records review and interviews conducted, the findings indicate that, 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 are mismanaging residents’ medications. It is alleged that staff are mismanaging residents’ medication by giving out one residents’ medication to another when first residents’ medication runs out. Fourteen (14) out of fourteen (14) staff interviewed stated that they have not observed the med-tech staff mismanaging the resident’s medication. The Med-techs and staff interviewed, stated that medication is administered as prescribed and logged into the Medication Administration Record. LPA's review of five (5) random resident medication, and medication administration records, shows that medication appears to be administered 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. Resident R1-R15 interviewed were unable to corroborate the allegation. Residents have no knowledge of this incident. Based upon records review and interviews conducted, the findings indicate that, 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. Con't 9099C....

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20240815132940

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: 10/11/2024

NARRATIVE

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Regarding the allegation: Staff are administering unprescribed medications to residents. It is alleged that the staff had administered unprescribed medications to the residents who misbehave during the night, by logging incorrect information of medication administered. Covering up the pill count. Fourteen (14) out of fourteen (14) staff interviewed stated that they have not observed the medication technician staff administer unprescribed medication to residents. The Med-techs stated that medication is administered as prescribed. The narcotics log used to record time, date and dosage administered to the resident(s). The narcotics medication(s) are audited randomly each month for each resident using medications containing heavy narcotics. Medication audits are performed monthly by the Wellness Director to ensure medications are being administered as prescribed by the physician orders, constant communications with the pharmacy via eMARs (electronic medication administered records) ensure consistent supply of all medications continues. LPA's review of five (5) random resident medication, and medication administration records, shows that medication appears to be administered as prescribed by physician orders and pharmacy orders. Resident R1-R15 interviewed were unable to corroborate the allegation. Based upon records review and interviews conducted, the findings indicate that, 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 answer the resident’s call button in a timely manner. It is alleged that staff are not answering the call button in a timely manner when residents call for assistance. Fourteen (14) out of fourteen (14) staff interviewed stated that they have not observed the staff not answering the call button switchboard in a timely manner. LPA observed a call come into the office by a resident asking for assistance, within 1-2 minutes a caregiver answered the office to acknowledge the call being handled, the call was answered by a staff person from the resident’s room. Residents R1-R15 interviewed stated that the caregivers come within 2-3 minutes after call is made on the residents’ call box, someone always answers. Based upon observations made and interviews conducted, the findings indicate that, 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......

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20240815132940

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: 10/11/2024

NARRATIVE

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Regarding the allegation: Staff do not ensure residents’ showering needs are being met. It is alleged that staff are not ensuring residents showering needs are being met. Fourteen (14) out of fourteen (14) staff interviewed denied the allegation. Caregiver staff and direct person staff(DSP) interviewed state, the caregivers staff assist the Home Health Aides with bathing the residents 2-3 times per week as noted in the resident’s needs/services plan. When residents refuse bathing, a note is made for bath refusal in the ADL (assisted daily living) clinical notes. Basic ADLs like brushing teeth, washing face, and combing hair, dressing is applied daily. Fifteen (15) out of fifteen (15) residents interviewed stated the staff gives baths twice a week, some residents stated they were given bathes three times a week by the home health agencies, the caregiver staff provides the rest. Based upon records review and interviews conducted, the findings indicate that, 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 facility has adequate food supply. It is alleged that the staff is not ensuring adequate food supply for residents. Fourteen (14) out of fourteen (14) staff interviewed denied the allegation. Kitchen staff interviewed state, grocery list is planned and ordered on Sunday and Wednesday for delivery of food on Monday and on Thursday. The kitchen was observed to have enough foods to feed all the residents, during tour of the kitchen LPA observed delivery being made, many boxes and bags of fruit and vegetable along with canned and dry food items being delivered. Fifteen (15) out of fifteen (15) residents interviewed state they like the food served and have never experienced food shortage at the facility. Based upon records review and interviews conducted, the findings indicate that, 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 attend scheduled medical appointments. It is alleged that a staff person is cancelling residents’ medical and other important appointments. Fourteen (14) out of fourteen (14) staff interviewed denied the allegation. The residents with medical appointments, relay information to the caregivers and the care coordinator, who then logs in the appointments in the transportation log to ensure the drivers are aware of resident’s appointments. The protocol for the appointment scheduling is verified by the care coordinator to ensure all necessary paperwork and insurance paperwork is ready for the residents. Fifteen (15) out of fifteen (15) residents interviewed stated they are happy with the transportation protocols and have not had any problems with keeping their appointments. Continued on 9099C....

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20240815132940

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: 10/11/2024

NARRATIVE

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Based upon records review and interviews conducted, the findings indicate that, 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’ air conditioner is in good repair. It is alleged that the staff is not ensuring that the air conditioner system is not in good repair. Fourteen (14) out of fourteen (14) staff interviewed denied the allegation. The air conditioner units are maintained by the maintenance staff, all air-conditioner systems are operational. When a unit breaks down or needs service, a work order is issued for maintenance to repair, repairs are handled within 24 hours unless parts are needed ordering. Accommodations for the residents are made if repair takes longer than anticipated. Regarding maintenance all work orders are logged to ensure completion of the projects in timely manner. Fifteen (15) out of fifteen (15) residents interviewed stated they have no concerns of the A/C units, staff is always fixing and are repairing things around the facility. Based upon records review and interviews conducted, the findings indicate that, 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.

LPA did not observe any Health and Safety concerns during the visit, an exit interview was held and copy of this report was given to the Administrator Maya Mnoyan.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC9099 (FAS) - (06/04)

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