198603535-12-5-2024-28-AS-TVAO-DBTTY7-20241210140816

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:14:28 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
11/04/2024 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241104144910

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: 143	DATE:	12/05/2024
		UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Ruth Via Wellness Director		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident resulting in a bruise
Staff do not ensure that resident's personal items are safeguarded
Staff did not prevent resident from inappropriately touching other residents
Staff do not speak to residents in a respectful manner
Staff did not ensure resident medications are properly managed
Staff do not provide residents with a sufficient amount of food.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complaint visit in regard to the allegations listed above. LPA met with Wellness Director Ruth Villa and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 11/12/2024, LPA interviewed Staff #1- Staff #7, Resident #1 -Resident #10, and toured the facility’s kitchen. LPA obtained copies of the following documents: staff roster, resident roster, identification and emergency information, Individual service plans, physician report for R1, food invoices, food menu, physicians order for R9 and staff records.

SEE 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

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 3

Control Number 28-AS-20241104144910

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: 12/05/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regard to the allegation that “Staff hit resident resulting in a bruise” the department previously investigated this allegation on 09/23/2024 and it was found to be unsubstantiated. LPA reviewed records, interviewed residents, and staff and no additional information was given.

In regard to the allegation that “Staff do not ensure that resident's personal items are safeguarded” it is alleged that R3 goes into residents’ room and steals money. During interviews with residents seven (7) out of ten (10) residents state they have not had any items missing from their rooms. One (1) resident R7 was in hospital and one (1) resident R1 was confused at time of interview. R5 stated that his/her roommate steals their clothes to sell. During interviews with staff four (4) out of seven (7) staff have not heard about items missing from resident’s room. S6 and S7 state that one resident was missing wallet but was unsure of where wallet was left. S6 states that R3 doesn’t steal and is very helpful to residents.

In regard to the allegation that” Staff did not prevent resident from inappropriately touching other residents ‘it is alleged that a resident goes into females’ rooms and touches them and has forced residents to kiss them. During interviews with residents eight (8) out of ten (10) residents state they have never witnessed any inappropriate touching between residents or been touched. One (1) resident R7 was in hospital and one (1) resident R1 was confused at time of interview. During interviews with staff six (6) out of seven (7) staff indicate they have never witnessed any inappropriate touching between residents. S6 stated that there are couples in the facility and that they do hang out like boyfriend and girlfriend. S7 stated there is holding hands between couples but it is consensual.

In regard to the allegation that “Staff do not speak to residents in a respectful manner” it is alleged that staff does not treat residents with respect and are mean to them. During interviews seven (7) out of ten (10) residents stated that staff talks to them with respect. One (1) resident R7 was in hospital and one (1) resident R1 was confused at time of interview. R9 stated “some do some don’t”. During interviews with staff six (6) out of seven (7) staff stated that staff speak to residents with respect. S5 stated that one staff was let go for not speaking to residents with respect.

SEE 9099C

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20241104144910

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: 12/05/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regard to allegation that “Staff did not ensure resident medications are properly managed” it is alleged that medications are not being ordered and that medicated shampoo for R9 is not available. During interviews with residents seven (7) out of ten (10) residents stated they get their medication when needed. One (1) resident R7 was in hospital at time of interview and one (1) resident R1 was confused at time of interview. R9 stated sometimes medication are late but that he/she has medicated shampoo in his/her room. Interviews with Four (4) staff reveled that only MedTech’s handle medication so they would not have any knowledge of medication. Interviews with two (2) staff stated that all medication is given and ordered on time and that the only delay would be if Drs. Approval is needed for refills. LPA conducted random check on five residents’ medication and no errors were observed at time of visit.

In regard to the allegation that “Staff do not provide residents with a sufficient amount of food” it is alleged that residents are given small portions of food and that residents are always hungry. During interviews with residents seven (7) out of ten (10) residents state there is enough food. One (1) resident R7 was in hospital and one (1) resident R1 was confused at time of interview. R9 stated” there is enough food, but I really don’t like it” R10 stated “There is enough for me. I can ask for more”. During interviews with staff five (5) out of seven (7) stated there was enough food. S2 had no knowledge of food supply. S3 stated that “we have never not had enough food”. S5 stated that they even get food to take to their rooms. LPA toured kitchen and food supply during time of visit and sufficient food supply was observed.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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.

An exit interview was conducted and copy of this report was left with the Wellness Director Ruth Villa.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3