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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 06/19/2025
Date Signed: 06/19/2025 04:50:14 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
06/10/2025 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20250610144343
FACILITY NAME:TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THEFACILITY NUMBER:
198603383
ADMINISTRATOR:JAKINI, ROBERTFACILITY TYPE:
740
ADDRESS:1155 VIA VERDETELEPHONE:
(909) 293-6466
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:60CENSUS: 41DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Subishsani Kumar TIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings while in care.
Staff do not ensure that resident is provided with clean clothing while in care.
Staff do not ensure that resident's room is maintained in a clean condition while in care.
Staff do not ensure that communications to the facility from resident's representative are answered promptly and appropriately.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Executive Director and the porpose of the visit was explained.
During today's visit LPA obtained copies of staff & residents Rosters, reviewed R1's file and collected relevant documents. Interviews conducted with Executive Director, Staff 1 - Staff 4 (S1 - S4) and Residents 1 - Residents 5 (R1 - R5). LPA conducted a tour of facility including R1's room and randomly chossen 5 other residents room.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250610144343
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 06/19/2025
NARRATIVE
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Regarding the allegation: Staff do not safeguard resident's personal belongings while in care. It was alleged that staff steal / use R1’s personal supplies (Depends, panties, wipes, gloves, wash cloths) for other residents. Also pair of shoes was missing for R1.

Interviewed staff denied the allegation. They stated that personal supplies and belongings didn't take from one resident and use for another. They stated staff never stole residents personal belongings. S1 indicated that there was one occasion that one of resident was missing a pair of shoes but was letter found and returned to them. Interviewed Executive Director stated that the community maintains an adequate inventory of hygiene, incontinence supplies to meet the needs of all residents. Interviewed staff mentioned that there are some residents family members who prefer to bring their own supplies but if they run low there are ample of house supplies that can be provided until family members bring items. LPA toured the facility and verified stock available of personal care items. LPA also checked R1's and randomly chosen residents room (incontinent care) and seen that each resident had their own items / supplies. Residents interviewed could not corroborate the allegation. Resident interviews revealed that staff did not steal residents supplies. They stated that their personal belongings are not missing.

Regarding the allegation: Staff do not ensure that resident is provided with clean clothing while in care. It was alleged that staff not laundering R1’s clothing and R1 wearing dirty clothing.

Interviewed staff denied the allegation. They stated that they will ensure residents were placed in clean clothing every day. They stated that they would change residents clothing often because some residents got food on their clothing at the time of meals. Staff would encourage residents to change clothes if residents declined to be changed. Interviewed Executive Director stated that staff adhere strictly to the assigned laundry schedule for each resident. Interviewed staff stated that residents didn't leave unattended and wearing dirty clothes. They stated that laundry for residents done on weekly basis and as needed. Interviewed residents stated that staff change their clothing every day. LPA observed residents at the common areas and in their rooms, and found they looked clean and properly dressed. Per LPA's observation, R1's and other residents clothes were clean. Staff did not leave residents in dirty clothing.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250610144343
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 06/19/2025
NARRATIVE
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Regarding the allegation: Staff do not ensure that resident's room is maintained in a clean condition while in care. It was alleged that R1’s room is often very dirty.

Interviewed staff denied the allegation. They stated facility and rooms are cleaned daily, and residents rooms are deep cleaned once a week and/or as needed. They stated there are accidents happened on a daily basis; however they communicate to each other and areas cleaned as soon as they see it is needed. Executive Director stated that staff clean the facility daily, and deep cleaning of resident rooms is done once a week and/or as needed. At the time of visit residents rooms including R1's room and common areas were inspected. R1's room and all other rooms and common areas were observed to be clean.

Regarding the allegation: Staff do not ensure that communications to the facility from resident's representative are answered promptly and appropriately. It was alleged that family member trying to speak with Administrator about their concern, but Administrator not returning their calls.

Interviewed Executive Director / Administrator and staff denied the allegation. Executive Director stated that residents are their priority. Any concerns raised by family members are taken seriously and addressed promptly. Stated that allays returned family members / responsible party's calls. Interviewed S2 stated when they answer the phone if someone not available, they will take a message with call back number and what the call is regarding. They let the person know they had a call as soon as possible and person / staff get back to them / caller as soon as they can. Interviewed Executive Director and staff stated that residents family members have their cell phone numbers and can contact to them directly (call, text). Also email was provided to family members.

Based on interviews conducted and observations made, there was insufficient evidence to prove the allegation(s). Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided Executive Director.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
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