300602548-4-5-2023-22-AS-SSAS-CQW2YP-20230414174901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300602548
Report Date: 04/05/2023
Date Signed: 04/05/2023 12:08:13 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/27/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230327122226

FACILITY NAME:	KATELLA SENIOR LIVING COMMUNITY		FACILITY NUMBER:	300602548
ADMINISTRATOR:	CHRISTINE GREENWAY		FACILITY TYPE:	740
ADDRESS:	3952 KATELLA AVENUE		TELEPHONE:	(562) 596-2773
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	140	CENSUS: 65	DATE:	04/05/2023
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Director of Nursing- Toni Sims Resident Care Coordinator- Rebekah Cross		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Staff do not have planned activities for the residents while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced complaint visit to the facility to initiate the 10-day visit for the complaint received on 3/27/23 and to deliver the findings. LPA was greeted by front desk staff, who contacted Director of Nursing (DON) Toni Sims and Resident Care Coordinator (RCC) Rebekah Cross about visit due to facility administrator being unavailable. LPA explained to DON and RCC about reason for visit.

For today's visit, there are a total of 65 residents in care of which 2 are on hospice. LPA conducted a tour of the interior portion of the facility with DON and RCC. During this visit, LPA conducted record reviews, interviews and obtained copies of pertinent documents.

SEE LIC9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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 22-AS-20230327122226

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KATELLA SENIOR LIVING COMMUNITY	FACILITY NUMBER: 300602548
	VISIT DATE: 04/05/2023

NARRATIVE

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This department has investigated the complaint alleging that staff do not have planned activities for the residents while in care

Upon entry to the facility, LPA observed the "Today's Activity's" posted at the front desk. LPA conducted a tour of the facility with DON and RCC and observed activity schedule posted in the following locations in assisted living portion of the facility: the front desk, in the elevator, on the wall and at the entry of the dining room. In the memory care portion of the facility, LPA observed the activities posted on the wall and on a whiteboard. LPA observed that per activity schedule, the facility provides activities such as but not limited to: religious services, fitness and exercise groups, Bingo, card games, art and crafts, trivia and movies. During the tour, LPA observed residents in the dining room doing an activity for both the assisted living and memory care portion.

LPA conducted a total of 10 interviews, which consisted of staff and residents, and 10 out of the 10 interviews did not corroborate with the allegation. During the interview with residents, LPA observed that each resident had a physical copy of the activity schedule, and was informed that the staff hand-delivers the activity schedule on a daily basis. Per interviews with staff, LPA was informed that not only do staff provide paper copies of the activities, but staff will provide residents verbal reminders about activities to increase in engagement and participation.

LPA conducted record reviews such as, but not limited to: the facility admission agreement, staff schedule, staff roster, resident roster, monthly activity schedule, activity director job description, and activity tracking log for residents both in assisted living and memory care.

Based on observations and review of documents obtained, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

For today's this visit, no citations were issues.

An exit interview was conducted with DON and RCC and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC9099 (FAS) - (06/04)

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