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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:33:29 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
11/06/2024 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241106101156
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: 142DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Ruth Villa, Wellness DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff mishandled a resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) S Vaid conducted a subsequent complaint visit on 11/14/24 regarding the listed allegation and to deliver complaint investigation findings. Met with Ruth Villa, Wellness Director and explained purpose of the visit. Toured the physical plant and did not observe any Health and Safety concerns.

On 11/12/24, Licensing Program Analyst (LPA) S Vaid conducted an initial 10-day complaint investigation visit for the above allegation. LPA met with Ruth Villa, Wellness Director and the purpose of the visit was discussed. The investigation consisted of the following: LPA toured the physical plant. LPA Interviewed staff 1-7 (S1-S7) and residents 1-14 (C1-C14). LPA collected and reviewed documents from C1's medication file, and copies of four (4) random residents: medication list, written physicians’ orders. Facility Plan of Operations regarding medication administration.

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: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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-20241106101156
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: 11/14/2024
NARRATIVE
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Regarding the allegation: Staff mishandled a resident's medication. It is alleged that the medication technician staff do not distribute the residents’ medications in a timely fashion. It is also alleged that six (6) medications pills were disposed by a new nurse (name not given), one hour later. Seven (7) out of seven (7) staff interviewed deny this allegation. The medication is administered to the residents at the correct times, AM, Noon, evening, PM, and bedtime. The medication is given to the residents within one hour before or one hour after the initial times. It is also confirmed by the physicians whom subscribe the medications and dosages, the morning medications are given between the hours of 6am to 8am for residents requiring morning medication. Noon medication is given between 11am to 1pm, evening medication is given between 5pm to 7pm and this occurs throughout the day. Med-techs also monitor residents who require medication administration every four (4) to six (6) hours. The medication that is refused by the residents is logged in the electronic medications administration record (EMAR) the refused medication is then properly disposed. Refused medications cannot be administered at any other times. Protocols for administering medications are being followed as per Plan of Operation regarding medications: delivery procedures for medications, section B thru section H: facility policies and procedures regarding, new medication order for current residents, medication direction changes, PRN medications, residents refusing medications, charting of medications.
Thirteen (13) out of Fourteen (14) residents interviewed stated they have gotten their medication daily and could not corroborate the allegations. Thirteen (13) residents stated, the med-techs speak to them while administering their medications and answer questions regarding their medication. Seven (7) out of fourteen (14) residents know the shape and size of their medications and are aware of the medications they are given.

Based on interviews conducted, observations made, and documents reviewed, residents’ medication list, written physicians’ orders, facility Plan of Operations regarding medication administration. 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 a copy of this report was given to Ruth Villa, Wellness Director.


NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2