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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 08/08/2024
Date Signed: 08/08/2024 03:50:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
08/06/2024 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240806100037
FACILITY NAME:OMEO ARCADIA LIVINGFACILITY NUMBER:
198603648
ADMINISTRATOR:ZHANG, JINGFANGFACILITY TYPE:
740
ADDRESS:601 SUNSET BLVDTELEPHONE:
(323) 422-8030
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:99CENSUS: 88DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jennifer LanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff did not administer resident medication as prescribed.
Facility staff did not maintain accurate records for resident.
Facility staff did not ensure that the resident needs were being met.
Facility staff did not respond to resident's call button for assistance.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Jennifer Lan and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Jennifer Lan, Staff 1-4 (S1-4), and Residents 1-8 (R1-8). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and S1-4's staff files and collected copies of documents pertinent to the investigation. LPA reviewed R1-8's Medication Administration Records (MARs) and collected copies for March 2024 and June - August 2024. LPA additionally conducted a tour of facility which included observations of common areas, dining room, resident rooms and medication room.


(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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 4
Control Number 28-AS-20240806100037
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 08/08/2024
NARRATIVE
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Investigation revealed the following: Regarding allegation, Facility staff did not administer resident medication as prescribed, it is alleged that facility staff are not providing R1 with their prescribed medications, Ivermectin and Permethrin cream as prescribed and that in March 2024, staff inaccurately provided R1 with Papyrus medication (Phos10) as they only administered 3 pills daily instead of providing 9 pills as prescribed (3 per meal). Interview conducted with Administrator Jennifer Lan revealed that facility staff only give residents the medication that is prescribed to each individual resident. Interviews conducted with S1-4 revealed that only prescribed medications are given to residents. S1-4 stated that once medications are given to residents they then initial each resident's MAR. LPA researched medication, Papyrus medication (Phos10), and LPA research did not reveal a medication with that name. LPA also did not observe medication Papyrus medication (Phos10) listed on R1's MAR. Interviews conducted with 8 residents revealed that they are satisfied with their medication management and do not have any concerns, they are given their medications on a timely manner by staff and as prescribed. LPA reviewed R1-8 MARs and did not observe anything that is of concern. LPA's observations of facility medication room did not reveal anything of concern. 8 out of 8 residents stated that they are satisfied with the services that they receive at the facility and stated that facility staff treat them with respect at all times. Based on LPA observations, LPA review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility staff did not maintain accurate records for resident, it is alleged that R1's Medication Administration Records (MARs), are not accurately maintained which revealed that the staff were not administering the medications as prescribed. Interview conducted with Administrator Jennifer Lan revealed that facility staff only give residents the medication that is prescribed to each individual resident and once medication is administered the individual MARs is completed for each resident. Interviews conducted with S1-4 revealed that only prescribed medications are given to residents. S1-4 stated that once medications are given to residents they then initial each resident's MAR. Interviews conducted with 8 residents revealed that they are satisfied with their medication management and do not have any concerns, they are given their medications on a timely manner by staff and as prescribed. LPA reviewed R1-8 MARs and did not observe anything that is of concern. LPA's observations of facility medication room did not reveal anything of concern. 8 out of 8 residents stated that they are satisfied with the services that they receive at the facility and stated that facility staff treat them with respect at all times. Based on LPA observations, LPA review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20240806100037
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 08/08/2024
NARRATIVE
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For allegation, Facility staff did not ensure that the resident needs were being met, it is alleged that R1 is not receiving proper care, as staff were not removing their bandages that stopped them from bleeding as requested, which led to an infection that required antibiotic treatment. R1 has also allegedly missed several dialysis appointments because staff did not prepare R1 in time. Interview conducted with Administrator Jennifer Lan and facility staff revealed that residents needs are met at all times. Administrator stated that R1 is seen by a home health nurse once a week for wound care and staff tend to R1's other needs as needed throughout the day and night on a daily basis. Staff stated that R1 is checked on every two hours or as needed and denied that R1 was not assisted with bandage removal and denied that R1 did not receive proper care from staff. Administrator stated that R1 has not missed dialysis appointments due to staff not preparing them in time. Interviews conducted with 8 out of 8 residents revealed that staff at facility do ensure that their needs are met at all times. R1 denied missing any dialysis appointments and stated that staff always assist them to be ready for their appointments. R1 stated that they received proper care from staff when needed and they not have any concerns. R1 stated that staff assist them in a timely manner when they use the pendant to request staff assistance and provide aid if they have a medical emergency. R1 stated that staff respond to a call button within 5 minutes and that staff check on them about every 2 hours throughout the night. LPA observed staff assisting residents and did not observe anything of concern. LPA observed that the facility has a functioning call system in place. Based on LPAs observations, review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility staff did not respond to resident's call button for assistance, it is alleged that staff are slow in responding to call bells and at times it takes hours for staff to provide assistance to resident. It is also alleged that R1 often wears the same stained and smelly clothing from the previous day. Administrator and staff denied the allegations and stated that staff respond to a resident's call button in approximately 4 minutes. They stated that staff also conduct rounds every 2 hours and tend to residents as needed. Staff denied that any resident wears the same clothing as they used the previous day and also stated that staff assist residents who received assistance with their Activities of Daily Living (ADLs) with a change of clothing in the morning and then again at bedtime. Staff stated that R1 uses the pull cord when they need assistance and staff immediately tend to the resident's needs. Staff stated they tend to residents who received assistance with their ADLs immediately when they have had an accident. They stated that every resident has a call button and staff respond to an alert immediately to check on residents and tend to their
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240806100037
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: OMEO ARCADIA LIVING
FACILITY NUMBER: 198603648
VISIT DATE: 08/08/2024
NARRATIVE
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needs. Staff stated that resident's laundry is done twice a week and as needed and that when a resident is changed in the morning only clean clothing is used. 8 out of 8 residents stated that they do not have any concerns with their clothing and they are happy with the laundry services as well as all other services that they receive at the facility. 8 out of 8 residents stated that staff respond to a call button signal in an appropriate amount of time, they are never made to wait for long periods of time and stated that staff are very helpful at all times. R1 stated that they have not used dirty clothing and stated that their daughter assists with their laundry. R1 stated that staff respond to a call button within 5 minutes and that staff check on them about every 2 hours throughout the night. LPA observed staff assisting residents and did not observe anything of concern. LPA observed that the facility has a functioning call system in place. LPA toured the facility laundry room and observed that the facility has a washer and dryer as well as products needed to wash resident's clothes and linens. LPA did not observe any resident wearing stained and/ or clothing carrying a foul odor when touring the resident rooms or when interviewing facility residents. Based on LPAs observations, review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Administrator Jennifer Lan.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4