198603648-10-7-2024-28-AS-RORN-DARV8N-20241106151257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 10/07/2024
Date Signed: 10/07/2024 06:01:38 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
08/20/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240820144404

FACILITY NAME:	OMEO ARCADIA LIVING		FACILITY NUMBER:	198603648
ADMINISTRATOR:	ZHANG, JINGFANG		FACILITY TYPE:	740
ADDRESS:	601 SUNSET BLVD		TELEPHONE:	(323) 422-8030
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	99	CENSUS: 80	DATE:	10/07/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jennifer JingFang Zhang		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained multiple injuries while in care.
Resident sustained multiple falls due to lack of supervision.
Staff did not report incidents to resident's responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above. LPA met Administrator, Jennifer Zhang and explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: during the investigation visit, LPA obtained staff/resident roster, reviewed/obtained resident#1’s (R1) records, interviewed residents from resident#2 (R2) to resident#7 (R7), attempted but unable to interview resident#1 (R1), interviewed staff from staff#1 (S1) to staff #2 (S2), interviewed visitor, and conducted a physical plant.

The investigation revealed the following:

(-continued on LIC9099C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

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-20240820144404

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: OMEO ARCADIA LIVING	FACILITY NUMBER: 198603648
	VISIT DATE: 10/07/2024

NARRATIVE

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In regard of allegation resident sustained multiple injuries while in care, it was alleged that resident had bruises on resident’s body when residing at the facility. LPA interviewed residents, six (6) out of seven (7) residents could not corroborate the allegation. One (1) out of seven (7) residents was able to be interviewed. All two (2) staff interviewed denied the allegation. Staff interviews revealed staff would conduct a physical check and evaluate residents if residents had bruises or fell. Staff would document the incident to the residents’ facility chat and notify residents’ responsible parties and report to resident’s physicians. As staff explained, the resident was on medication that could make the resident prone to have bruises even without being touched. Per visitor’s interview, a resident was observed to have bruises on the resident’s back but unsure the actual cause of them. Visitor indicated the facility staff had taken preventive actions on checking the resident. Per record reviews, resident’s records indicated staff had document resident’s fall or bruises in residents’ facility chat. Thus, there was not preponderance of evidence to show resident sustained multiple injuries while in care.

In regard of allegation resident sustained multiple falls due to lack of supervision, it was alleged that resident fells when residing at the facility. Per residents’ interviews, all six (6) residents who were interviewed could not corroborate the allegation. Residents stated staff provided proper supervision to them and residents did not experience falls. All two (2) staff interviewed denied the allegation. Staff interviews revealed staff would assist residents if residents were fell and conduct a physical check to evaluate residents. Staff would document the incident to the residents’ facility chat, notify residents’ responsible parties/ Licensing, and report to resident’s physicians. Per visitor’s interview, a resident had fallen in the facility around Feb 2024 and the staff had taken preventive actions on checking the resident. (-continued on LIC 9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240820144404

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: OMEO ARCADIA LIVING	FACILITY NUMBER: 198603648
	VISIT DATE: 10/07/2024

NARRATIVE

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Per record reviews, resident’s records indicated staff had document resident’s fall in residents’ facility chat. Thus, there was not preponderance of evidence to show facility did not provide supervision and cause residents’ falls while in care.

In regard of allegation staff did not report incidents to resident's responsible party, it was alleged that staff did not report resident’s bruises or falls to resident’s responsible parties. LPA interviewed residents and all six (6) residents who were interviewed could not corroborate the allegation. All two (2) staff interviewed denied the allegation. Staff interviews revealed staff had to report incidents to administrator and administrator would report the incidents to residents’ physicians, responsible parties, and Licensing. Staff would document the incident to the residents’ facility chat as well. Per visitor’s interview, a resident reported to the responsible party of an unwitnessed fall at the nighttime; however, visitor was unsure the resident had reported to the night staff of that fall. Per record reviews, staff had reported the incidents of resident’s fall to Licensing when staff was aware of the falls. Thus, there was not preponderance of evidence to show staff failed to report incidents to resident’s responsible party.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Jennifer and findings were discussed. A copy this report was provided to Administrator at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

LIC9099 (FAS) - (06/04)

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