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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603597
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:14:08 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
03/05/2024 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240305095603
FACILITY NAME:ALHAMBRA SENIOR VILLAFACILITY NUMBER:
198603597
ADMINISTRATOR:PHAM, LISAFACILITY TYPE:
740
ADDRESS:1 E COMMONWEALTH AVETELEPHONE:
(626) 289-3871
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:176CENSUS: 94DATE:
03/12/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Madeleine Sievert, Wellness Coordinator TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are not showering residents timely
Staff are not changing residents timely
Staff are not assisting residents with medications timely
Staff are not providing residents with basic hygiene products
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint investigation regarding the above allegations. LPA met with Wellness Coordinator, Madeleine Sievert who assisted with the visit. Administrator, Lisa Pham arrived at the facility later, and also assisted with the visit.

Regarding the allegation that : Staff are not showering residents timely. The investigation consisted of interviews with Administrator, Staff #1- Staff #7, and Resident #1- Resident #7. LPA also reviewed caregiver assignment sheets with shower schedule. Staff interviewed did not corroborate the allegation. Six out of eight staff interviewed stated that staff do shower residents timely. Residents interviewed were not able to corroborate the allegation. Seven out of seven residents stated that either they do not need assistance with showering or they do receive assistance timely.

Regarding the allegation that : Staff are not changing residents timely. The investigation consisted of interviews with Administrator, Staff #1- Staff #7, and Resident #1- Resident #7. LPA also reviewed caregiver assignment sheet with bathroom assist schedule.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
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-20240305095603
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: ALHAMBRA SENIOR VILLA
FACILITY NUMBER: 198603597
VISIT DATE: 03/12/2024
NARRATIVE
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Staff interviewed did not corroborate the allegation. Six out of eight staff interviewed stated that staff dochange residents timely. Residents interviewed were not able to corroborate the allegation. Seven out of seven residents stated that either they do not need assistance with changing, or they do receive assistance timely.

Regarding the allegation that : Staff are not assisting residents with medications timely. The investigation consisted of interviews with Administrator, Staff #1- Staff #7, and Resident #1- Resident #7. Staff interviewed did not corroborate the allegation. Six out of eight staff interviewed stated that staff do assist with medications in a timely manner. Residents interviewed were not able to corroborate the allegation. Seven out of seven residents stated that either they handle their own medication, or they do receive assistance with their medications in a timely manner.

Regarding the allegation that : Staff are not providing residents with basic hygiene products. The investigation consisted of interviews with Administrator, Staff #1- Staff #7, and Resident #1- Resident #7. LPA also observed facility hygiene supply. Staff interviewed did not corroborate the allegation. Seven out of eight staff interviewed stated that staff do provide residents with basic hygiene products. LPA observed that the facility has a supply of hygiene products for residents. Residents interviewed were not able to corroborate the allegation. Seven out of seven residents stated that they either have their own hygiene products, or the staff have provided them with hygiene products.

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.

Exit interview conducted, and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2