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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/21/2024
Date Signed: 10/21/2024 01:15:20 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
09/20/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240920160331
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:MAYA S MNOYANFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 143DATE:
10/21/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jacqueline CortezTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Personal Rights/Resident sustained an unexplained injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced visit to interview Resident #3 (R-3) through Resident #7 (R-7) and deliver findings. LPA met with Jacqueline Cortez and explained the purpose of this visit.

On 09/23/24, LPA Irra conducted the initial investigation visit. During this visit, LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA reviewed Resident #1 (R-1's) and Resident #2 (R-2) files and obtained relevant documentation. Additionally, LPA obtained a copy of the staff roster and a copy of the Resident roster.

During the course of this investigation, Investigator Christine Ferris (Department of Social Services- Investigative Bureau/IB) interviewed R-1, R-2, Staff #1 (S-1), Staff #2 (S-2), Staff #3 (S-3), Staff #4 (S-4) and Staff #5 (S-5). Investigator Ferris also obtained documentation from Los Angeles County Sheriff-Temple City Station pertaining to this allegation. On 10/21/24, LPA interviewed R-3 through R-7. ***Refer to LIC 9099C for the continuation of this report**
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
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 2
Control Number 28-AS-20240920160331
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: 10/21/2024
NARRATIVE
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Allegation: Personal Rights/Resident sustained an unexplained injury while in care. It has been alleged that a bruise was observed on R-1’s right rib area. Per Investigator Ferris’ investigation, R-1 did not disclose how R-1 sustained the bruise nor did R-1 disclose abuse or concern for neglect. Per Investigator Ferris’ investigation, staff interviewed denied knowledge of how R-1 sustained the bruise. Additionally, the Los Angeles County Sheriff’s Department determined no crime was committed. The investigation revealed no evidence to support abuse or neglect. R-3 through R-7 interviews revealed that they do not have any concerns, they have not heard of anyone complaining about this matter and that they feel safe residing at this facility. Interviews and police documentation do not corroborate this allegation.

Although the allegation may have happened or are 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, appeal rights and a copy of this report was provided to Jacqueline Cortez.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2