198603648-11-13-2023-28-AS-RORN-CZ6QTK-20240104112715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 11/13/2023
Date Signed: 11/13/2023 01:56:39 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
11/06/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231106121856

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: 78	DATE:	11/13/2023
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Jennifer Lan - Administrator		TIME COMPLETED:	02:11 PM

ALLEGATION(S):

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Staff do not assist resident with incontinence needs.
Staff do not monitor resident for change in condition.
Staff spoke inappropriately to a resident.
Staff do not respond to resident's call button for assistance.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Jennifer Lan (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the resident and staff rosters, interviewed Administrator, Staff 1 - Staff 3 (S1 - S3), and Resident 1 - Resident 8 (R1 - R8).

The investigation revealed the following: regarding the allegations "staff do not assist resident with incontinence needs" and "staff do not monitor resident for change in condition", it is alleged that an incontinent resident is not being checked every 2 hours for a diaper change in the night shift and staff are not changing the resident's diaper. Administrator and staff denied the allegation and stated that they are checking every 2 hours or as needed, and diaper change is being provided. Residents interviewed could not corroborate the allegation. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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-20231106121856

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: 11/13/2023

NARRATIVE

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Regarding the allegations "staff spoke inappropriately to a resident" and "staff do not respond to resident's call button for assistance", it is alleged that a staff told a resident that if the resident keeps pressing the call button for assistance they will not come to assist. Administrator and staff denied the allegation. Residents interviewed could not corroborate the 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 and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

LIC9099 (FAS) - (06/04)

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