306006452-9-9-2024-22-AS-AORZ-DD8U56-20250124141612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 09/09/2024
Date Signed: 09/09/2024 03:48:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
06/10/2024 and conducted by Evaluator Dwayne L Mason

COMPLAINT CONTROL NUMBER: 22-AS-20240610144900

FACILITY NAME:	ANAHEIM PALACE		FACILITY NUMBER:	306006452
ADMINISTRATOR:	CHON, CHRISTINE M		FACILITY TYPE:	740
ADDRESS:	525 W. LA PALMA AVE		TELEPHONE:	(626) 252-7287
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	199	CENSUS: 196	DATE:	09/09/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Susan Lee, Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility does not provide hygiene items for residents
The facility does not provide food in the quantity necessary to meet the needs of the residents
Facility is not providing activities for residents

INVESTIGATION FINDINGS:

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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by reception staff. LPA met with Susan Lee, Executive Director and explained the nature of the inspection.

The department received a complaint on 6/10/2024 stating facility does not provide hygiene items for residents, facility does not provide food in the quantity necessary to meet the needs of the residents and facility is not providing activities for residents. During the investigation, the department interviewed Executive Director (ED), staff and residents in care.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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 22-AS-20240610144900

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ANAHEIM PALACE	FACILITY NUMBER: 306006452
	VISIT DATE: 09/09/2024

NARRATIVE

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(continued from LIC9099)
On 6/14/2024 LPA obtained copies of the Personnel roster, Resident roster date 6/11/2024, the activity calendar and menu for the month of June, activity program description, food service policy and incontinence care plan. LPA conducted interviews with Executive Director, staff and residents in care.

In regards to the allegation of facility does not provide hygiene items for residents, LPA conducted interviews with Executive Director, staff and residents in care. LPA conducted interviews with Executive Director (ED). ED stated facility provides blue pads to any residents who are incontinent in Assisted Living (AL) and Memory Care (MC). ED stated facility provides hygiene supplies to all residents in Memory Care. ED stated that the facility does not sell wipes to residents. LPA conducted interviews with Caregivers (C1, C2, C3, C4, C5). All caregivers stated the facility provides blue pads and hygiene supplies residents in memory care and other incontinent residents. C2 stated the facility stopped supplying wipes to the entire facility in June. Other caregivers stated they were not sure if the entire facility receives wipes. LPA conducted interviews with Residents who were identified as receiving incontinence care (R9-R19). No disclosures were made regarding the allegation from the eleven residents interviewed with regards to hygiene supplies for incontinence.

In regards to the allegation of facility does not provide food in the quantity necessary to meet the needs of the residents. LPA toured the kitchen and dining area during meal times on 8/20/2024 and 8/22/2024. LPA conducted interviews with Kitchen Staff (K1, K2, K3, K4, K5). All kitchen staff stated, the facility provides residents with additional helpings of food upon request. Kitchen staff stated snacks are offered three times a day at 10:30am 2:30pm and 6:30pm. Kitchen staff stated snacks offered in the dining area or on the 2nd and 3rd floor activity area. LPA also observed meals and snacks being delivered to resident rooms. LPA obtained photo of a tray of snacks from the 2nd floor of the facility that residents had already gotten snacks from. LPA observed tray to have crackers, chips, bananas, applesauce and granola bars. LPA conducted interviews with Residents (R1, R2, R3, R4, R5, R6, R7 and R8). Based on interviews, R1, R2, R3, R4, R6 and R8 stated that meal portions are fine. All residents stated they are able to get additional helpings of food if they want. R1, R2, R3, R4, and R6 stated there are snacks at the facility three times a day.

In regards to the allegation of facility is not providing activities to residents, LPA interviewed Activity Staff (A1, A2, A3, A4, A5). A1 and A3 stated A1 is Activities Director working part time until September.
(continued on LIC9099-C)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20240610144900

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ANAHEIM PALACE	FACILITY NUMBER: 306006452
	VISIT DATE: 09/09/2024

NARRATIVE

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(continued from LIC9099-C)

A1 and A3 stated A3 is the full-time activities staff currently. LPA verified A3’s full-time status via August 2024 staff schedule. LPA observed activities taking place on 8/20/2024 and 8/22/2024. On 8/20/2024, LPA obtained photos of two Activity Assistants leading a group of 11 residents in seated stretches during the scheduled ‘Exercises & Bingo Game’ activity in the dining room. On 8/22/2024, LPA obtained photos of the Activities Director leading a group of 8 Memory Care residents in the scheduled ‘Bingo’ activity in the 2nd floor activity room. LPA observed both activities during the corresponding time and date on the activities calendar. LPA interviewed residents (R1, R2, R3, R4, R5, R6, R7 ,R8) regarding activities. Based on interviews conducted, R1, R2, R5, R6, R7 and R8 participate in activities and state there are enough activities and facility staff encourage residents daily to participate.

Regarding the allegation of facility does not provided hygiene items for residents, LPA reviewed records and conducted interviews with staff and residents. LPA observed staff administering incontinence care with blue pads and wipes. LPA observed blue pads and wipes stored in the MedTech room. Based on interviews conducted and records obtained, LPA determined facility is providing hygiene supplies to residents. Regarding the allegation of facility does not provide food in the quantity necessary to meet the needs of the residents, LPA determined six out of eight residents interviewed do not think portions are an issue. LPA observed five different meal options between two different meal times and observed food to be appropriately portioned. Based on all resident interviews, additional servings are available upon request. Five out of eight residents interviewed stated snacks are provided three times a day. LPA observed snacks offered in dining room, kitchen and on the 2nd floor activity area. Based on observations and interviews conducted, LPA determined the facility does provide food in the quantity necessary to meet the needs of the residents. Regarding the allegation of facility is not providing activities for residents, LPA interviewed staff and residents. Based on observations and interviews conducted, LPA determined the facility is providing activities for residents. Based on interviews conducted, observations made and records reviewed there is insufficient evidence to support the above allegation(s). Although the allegation(s) may have happened or are valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with Executive Director, Susan Lee. A copy of this LIC-9099 was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC9099 (FAS) - (06/04)

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