198603535-5-22-2025-28-AS-FFIS-DKBM9M-20250807092456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 05/22/2025
Date Signed: 05/22/2025 05:58:15 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
05/16/2025 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20250516122852

FACILITY NAME:	SANTA ANITA ASSISTED LIVING		FACILITY NUMBER:	198603535
ADMINISTRATOR:	JOEL NIBBLET		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVENUE		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	150	CENSUS: 149	DATE:	05/22/2025
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Jacqueline Cortez-Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are mismanaging resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sanjay Vaid conducted an initial 10-day complaint visit to investigate the listed allegation. The purpose of the visit was explained to Administrator- Jacqueline Cortez and Wellness Director- Ruth Villa. LPA Vaid conducted a tour of the facility and did not observe any health and safety concerns.

The investigation consisted of the following: Requested, obtained and reviewed ten (10) residents face sheets and identification, physicians’ reports, physician orders and MARs January 2025 to present (5/21/25), staff and resident roster, staff rosters by department. List of residents with medication insurance issues, list of self-medicating residents.

Regarding the allegation: Facility is not properly managing resident's medication. It is alleged that the staff are not administering prescribed medications to the resident, staff have failed to give the residents their medications as ordered. Continued on 9099C..................

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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-20250516122852

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: 05/22/2025

NARRATIVE

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Five (5) out of five (5) staff interviewed deny this allegation. According to the staff, the medications are administered to residents as ordered from their physicians. The staff stated they keep watchful eye over the medications management to the residents, staff are following and managing protocols for administering medications. Staff contacts the physicians and pharmacy when the physician orders are not clear or missing vital information. Medications to the residents are administered by medication management and protocols; staff locates the resident, opens resident profiles in the MARs (medication administered record), matches names to the bubble packed meds, checks the time and dosage, matches the pills to picture shown on screen, some residents will inquire of new medications. Discontinued medications will appear in the MARs, and the medications is disposed. Medication refusal is entered into MARs to communicate to next shift of the residents’ medications issues. Ten (10) out of fourteen (14) residents interviewed could not corroborate this allegation, residents interviewed stated that their medications are available after prescribed by the doctor and processed through the pharmacy. A few residents stated they like to see the medication before they take it. A few residents interviewed stated they self-administer their own medication. Eight (8) out of fourteen (14) residents stated that the facility is correctly managing their medications and have not had issues with receiving their medications. Based on records reviewed, interviews conducted, and observations made, 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.

A copy of this report was given to Wellness Director Ruth Villa.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

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