198603550-6-18-2024-28-AS-RORN-D6LL72-20240626082936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603550
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:37:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/12/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240612140945

FACILITY NAME:	WEST PARK SENIOR LIVING		FACILITY NUMBER:	198603550
ADMINISTRATOR:	CRYSTENE CHAR		FACILITY TYPE:	740
ADDRESS:	801 CYPRESS WAY		TELEPHONE:	(626) 339-5426
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	200	CENSUS: 102	DATE:	06/18/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Crystene Char		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not following residents physicians order for a special diet
Due to lack of supervision, residents money was stolen from residents wallet

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Crystene Char and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit the following occurred:
Resident and Staff Roster was submitted.
Review of Resident R1's file was done and Physician's Report, Resident Agreement and Emergency ID page was submitted.
Tour of the dining room and kitchen was conducted at 10:00 AM.
Interview was conducted with the Administrator at 9:35 AM and Staff S1 at 10:10 AM.
Interview was conducted with Resident's R1-R7 from 10:30 AM to 11:30 AM.
In regards to the allegation Staff are not following residents physicians order for a special diet, based on interviews conducted and information gathered 6 of 7 residents stated that they have choices and sugar free meals are provided. They also have vegetarian meals. They can also have substitute meals.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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-20240612140945

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WEST PARK SENIOR LIVING	FACILITY NUMBER: 198603550
	VISIT DATE: 06/18/2024

NARRATIVE

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Also stated the food is good and nutritious.
Interview with Staff S1 who stated that everyday on menu they have sugar free items and there is a diet board with pictures of those who are on a diabetic diet.
Stated that Resident R1 chooses his own meals and they can help set manage it.
Also stated that R1 is non-compliant and will often choose cheeseburgers.
Spoke with Administrator who stated that R1 is independent and chooses his own meals.
Stated that there is not a written order from the doctor specifying a specific diet.
Resident Agreement signed 06/01/2022 under section 6E Meals states we will accommodate some special diets if prescribed by your physician as a medical necessity.
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.

In regards to the allegation Due to lack of supervision, residents money was stolen from residents wallet, based on interviews conducted and information gathered it was revealed by R1 that he has been here 20 months and in his 1st month here he told the facility that he did not want staff in his room.
Interviews with 6 of 7 residents who all stated that they have never had their belongings taken from their room. 1 resident who knows R1 stated that she is very suspicious of R1's allegation because no one else on floor had items stolen.
Interview with staff who all stated that there have been no complaints about items stolen from their room.

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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC9099 (FAS) - (06/04)

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