198603648-1-14-2025-28-AS-RORN-DDCMU2-20250128085424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603648
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:31:01 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
11/14/2024 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241114164512

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: 82	DATE:	01/14/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Jingfang Zhang, Executive Director		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff did not administer medication to a resident in care.
Staff caused an injury to a resident in care.
Staff did not seek medical attention in a timely manner for a resident in care.
Staff did not prevent a resident from developing an infection while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met the Executive Director, Jingfang Zhang and explained the purpose of today's visit.

On 11/19/24, the initial investigation visit was conducted. The investigation consisted of the following:

LPA reviewed and requested copies of Resident #1 (R1) file documents such as Medication Administration Records for (September 2024, October 2024), Medication Physician’s Orders, Physician’s Report, Incident Reports pertaining to R1. LPA also requested Staff and Resident Roster. LPA also interviewed Resident #2 (R2) to Resident # 9 (R9), Admin, and Staff #1 (S1) to Staff #5 (S5) and Witness #1 (W1). Since R1 was in the hospital and was unable to be contacted for an interview on the date of the visit. LPA also reviewed a random sample of medications. During today's visit. LPA obtained documents on staff training. LPA observed no health or safety concerns.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

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 3

Control Number 28-AS-20241114164512

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OMEO ARCADIA LIVING	FACILITY NUMBER: 198603648
	VISIT DATE: 01/14/2025

NARRATIVE

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Allegation: Staff did not administer medication to a resident in care. It is alleged that the facility staff was supposed to administer medication to the resident to prevent the potassium levels from being high and the facility did not administer the medication. During initial visit, LPA reviewed a random sample of medications of five (5) residents and all medications are given as prescribed. During the initial visit, LPA interviewed four (4) out of four (4) staff that help administer and they all denied the allegation. During the initial visit, LPA interviewed five (5) out of five (5) residents that receive medication management care all claim to receive all medication as prescribed from the staff. During the initial visit, LPA reviewed R1's medications, Doctor’s Prescription Request, and Medication Administration Record, all medications are given as prescribed. There is not enough evidence to substantiate.

Allegation: Staff caused an injury to a resident in care. It is alleged that the staff banged the resident’s leg causing a bruise and noticed that the resident was in pain and that the leg was discolored. During the initial visit, LPA interviewed nine (9) out of nine (9) staff and they all denied the allegations and eight (8) out of eight (8) residents interviewed all said they have not experienced an injury due to staff nor witness any staff injure staff. Based on W1 interviewed, it was noted that R1’s injury on his leg was not caused by staff but due to declining health. Staff stated on being trained on elder abuse prevention and safe bed transfers. Based on record review, LPA obtained documents on staff training for preventing elder abuse, safe bed transfers, and preventing body injury. There is not enough evidence to substantiate.

Allegation: Staff did not seek medical attention in a timely manner for a resident in care. It is alleged that that the resident had been complaining of pain since 5 PM that day and that staff gave the resident Tylenol and was not transported to the hospital until 2 AM. Two (2) out of nine (9) staff interviewed was present on the date of the incident and work closely with R1 and kept in contact with R1’s primary family contact throughout the day. Two (2) of nine (9) staff interviewed stated that R1’s vital signs were normal and R1 did not complain of any leg pain on 10/31/2024 to 11/01/2024. However, at 2am, R1’s body temperature was measured at 101.7 degrees F and R1 complained of body pain so the staff immediately contacted R1’s primary contact and contacted the paramedics which transferred R1 to the hospital. Since the staff followed protocols of monitoring the R1 throughout the day, checking his vitals and body temperature, and providing medications when needed, there is not enough evidence to substantiate.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20241114164512

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OMEO ARCADIA LIVING	FACILITY NUMBER: 198603648
	VISIT DATE: 01/14/2025

NARRATIVE

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Allegation: Staff did not prevent a resident from developing an infection while in care. It is alleged that due to not getting medical attention in a timely manner and injury caused by the staff, R1 developed an infection called Cellulitis and in the hospital. Nine (9) out of nine (9) staff interviewed denied the allegation. Eight (8) out of eight (8) residents interviewed denied the allegation and have not experienced developing an infection while under staff care. W1 interviewed also denied the allegation. Wound care nurse visits three times a week to visit and treat R1 and conduct body checks. By observing client notes dated 10/01/24 to 10/30/24 by the wound care nurse, there are no reports of open wounds or infections. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held with the Executive Director, Jingfang Zhang and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025

LIC9099 (FAS) - (06/04)

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