Royal Vista San Gabriel

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to investigate the above allegations. The purpose of the visit was explained to new Administrator Sarah Rafael. The investigation consisted of the following: On 3/26/2024, a physical plant tour of the facility, record review, and interviews of staff (S3- S8) and residents (R1-R4) were conducted. Staff (S1) is presently suspended and staff (S2) was terminated March 24, 2024, therefore, were not interviewed. Resident (R1 & R2's) and staff (S1 & S2) file records were obtained. On 3/27/2024, staff (S1, S9, S10) were interviewed telephonically. During today's visit, record review was completed, residents (R5- R9) and staff (S11) were interviewed, a collateral visit to the San Gabriel Police Department was conducted. NOTE: New Administrator began working at the facility on June 3, 2024. Licensee failed to notify CCL of Administrator change. Therefore, a CM visit was created. ***Report narrative continues next pageRead the full finding— CDSS inspection report, August 27, 2024 · control 28-AS-20240322105813

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to finalize complaint and deliver findings on the above allegation. The purpose of the visit was explained to Wellness Nurse Elizabeth Contreras. Administrator Nelida Arlante. The investigation consisted of: On 10/12/2021, staff (S2- S6) and residents (R1 - R3) were interviewed. Staff (S1) was not interviewed because staff (S1)/Resident Care Coordinator was placed on a suspension leave on 9/29/2021 pending investigation. The following documents were reviewed/obtained: Resident (R1's) Identification and Emergency Information, Physician Report, Admission Agreement, Assisted Living Waiver Individual Service Plan, and Client/Residential Personal Property and Valuables documents, copy of staff (S1's) job description and Employee Counseling Report, resident roster and LIC 500 Personnel Report. In addition, a total of 30 resident Authorization for Credit Card Use documents were obtained. On 10/26/2021, LPA intervieRead the full finding— CDSS inspection report, November 13, 2023 · control 28-AS-20211005163109

Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met with Nelida Estrella Arlante, administrator. LPA explained the purpose of today's visit regarding the above-mentioned allegation. Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #4 (S4) and attempted to interview staff#5 (S5); interviews residents from resident#1 (R1) to resident#5 (R5); reviewed resident records; and toured the facility. LPA obtained copies of staff and resident rosters; and resident#1/ staff files with relevant information. In regard to allegation of “staff handled resident in a rough manner resulting in resident falling,” it was alleged that facility staff pulled resident through resident’s sleeve and resident fell. The investigation revealed the following: LPA interviewed residents, all five (5) residents interviewed could not corroborate the allegation. Three (3) outRead the full finding— CDSS inspection report, August 24, 2023 · control 28-AS-20230818093551

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the above allegations. The purpose of the visit was explained to Nelida Arlante. The investigation consisted of the following: On 6/1/2023, a physical plant tour of the facility, staff (S1- S3). and resident (R1) were interviewed. Resident (R1's) file documents [Face Sheet, bill (5/4/2023), Physician's report, Resident Appraisal, Appraisal Needs/Services Plan, LIC 500 Personnel Report, and roster were reviewed and obtained. During today's visit, incident report dated (4/25/2023) was provided. LPA interviewed four (4) responsible parties, staff (S4) and residents (R2-R4). *** report narrative on next page. SubstantiatedRead the full finding— CDSS inspection report, June 26, 2023 · control 28-AS-20230530124614

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the above allegations. The purpose of the visit was explained to Administrative Assistant Sau Lee. Interim Administrator Nelida Arlante works next door at the Skilled Nursing Facility (SNF) and arrived later. Administrator on record Chia Demurjian is not available due to leave of absence. The investigation consisted of the following: A physical plant tour of the facility with a focus on water supply/plumbing operation, facility maintenance, and Emergency and Disaster Plan responsibilities. A copy of LIC 610D Emergency and Disaster Plan, LIC 500 Personnel Report, resident roster. Staff (S1-S3) and residents (R1- R6) were interviewed. *Change of Administrator documents are still pending. See next page. SubstantiatedRead the full finding— CDSS inspection report, May 1, 2023 · control 28-AS-20230425105928

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the able allegation. The purpose of the visit was explained to Wellness Nurse Elizabeth Contreras. Administrator Chia Demurjian is not available due to short term leave of absence. The investigation consisted of the following: Medication Administration Records (MAR) and resident (R1's) file was reviewed. Resident (R1's) medications were reviewed. Documentation errors on MARs were noted. Staff (S1-S5) and residents (R1-R5) were interviewed. Resident (R1's) medication records were reviewed. The following documents pertaining to R1 were obtained: Identification and Emergency Information, Face Sheet, Physician Report, Medication Administration Records (Aug. 2022- March 2023), Physician orders Aug 2022- to present, LIC 500 Personnel Report, and resident roster. See LIC 9099C for report continuation. SubstantiatedRead the full finding— CDSS inspection report, March 24, 2023 · control 28-AS-20230321092912

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to deliver findings on the above allegation. LPA met with Administrator Chia Demurjian. The investigation consisted of the following: On 11/17/2020, Administratror/staff (S1) & staff (S2) were interviewed. Documents pertaining to resident (R1) were requested but not received on that date. Administrator Susana Fuentes stated that she did not get approval from the corporate office to provide to CCL the requested documents. On 11/19/2020, the following documents were received: Identification and Emergency Information/Face Sheet, Admission Agreement, Physician Report, Appraisal/Needs and Services Plan, Home Health records, Medication Administration Records [Medication Administration Records (MAR) January 2020- August 2020], Power of Attorney documents, caregiver notes, physician orders, psychiatry progress notes, skin body checks, care plan, LIC 500 Personnel Report, and resident roster. See LIC 9099C for continRead the full finding— CDSS inspection report, January 26, 2023 · control 28-AS-20201109094754

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the able allegation. The purpose of the visit was explained to Wellness Nurse Elizabeth Contreras. Administrator Chia Demurjian arrived later. The investigation consisted of the following: A physical plant inspection of the facility was conducted. Staff (S1-S6) and residents (R1-R6) were interviewed. A total of six (6) medication records were audited; no errors were found today. Resident (R1) file documents were obtained [ Identification and Emergency Information, Physician Report, Medication Administration Records, LIC 500 Personnel Report, resident roster, and staff schedule were obtained. Resident (R2's) Medication Administration Records were obtained. A picture of the medication that was provided in error to R1 was obtained. See LIC 9099C SubstantiatedRead the full finding— CDSS inspection report, January 26, 2023 · control 28-AS-20230124134758

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Regina-Aguilar Guevara and explained the reason for the visit. The purpose of the visit is a subsequent visit to deliver the findings from the original complaint dated 1/7/2022. At visit 4/13/2022 at 10:05 AM Administrator Regina-Aguilar Guevara was interviewed. Resident's 1-3 were interviewed from 10:20 AM to 10:50 AM. Case Manager for Resident 1 was interviewed telephonically at 11:00 AM. At visit 1/11/2022 LPA obtained copies of; staff roster and client roster, physician report for Residents #1-2 (R1-R2), and daily notes for the months of December 2021 and January 2022 for Residents #1-4(R1-R4). LPA requested physician report for Resident #3-4 (R3-R4) to be emailed to LPA by 5 PM. on 1/12/2022. In regards to the allegation Facility did not transport resident to medical appointments, based on the interviews conducted and information gathered Client C1 stated that dRead the full finding— CDSS inspection report, April 26, 2022 · control 28-AS-20220107134705

Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegation.The purpose of the visit was discussed with Administrator Regina Guevara. The investigation consisted of: LPA toured the interior of the facility, Memory Care Unit, and audited resident's medications. Staff (S1-S5), residents (R1-R7), and R1's pharmacy were interviewed. The following documents were obtained: resident (R1's) Face Sheet, Physician Report, Medication Administration Reports [Jan 2022- March 2022], LIC 500 Personnel Report, and resident roster]. LPA requested copies of the Plan of Operation and staff job descriptions, but did not obtain the documents because Administrator does not have copies. As a result, a case management deficiencies report was created. See LIC 9099C for report continuation. SubstantiatedRead the full finding— CDSS inspection report, March 4, 2022 · control 28-AS-20220303150219