197602334-7-26-2021-28-AS-CYEE-C925HZ-20211122185911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602334
Report Date: 07/26/2021
Date Signed: 07/26/2021 03:11:47 PM

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
04/07/2021 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210407152438

FACILITY NAME:	PASADENA HIGHLANDS		FACILITY NUMBER:	197602334
ADMINISTRATOR:	KAY LYNN CANO		FACILITY TYPE:	740
ADDRESS:	1575 EAST WASHINGTON BOULVARD		TELEPHONE:	(626) 791-1981
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	0	CENSUS: 151	DATE:	07/26/2021
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Executive Director		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident is being financially abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent complaint visit to investigate the above allegation. The initial investigation was conducted on 04/14/2021.

On 04/14/2021, at approximately 3:00 P.M., LPA inteviewed Business Administrator and requested relevant documentation. During today's visit, LPA interviewed the Executive Director, Assisted Living Director and R-1. LPA reviewed file for R-1.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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 28-AS-20210407152438

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: PASADENA HIGHLANDS	FACILITY NUMBER: 197602334
	VISIT DATE: 07/26/2021

NARRATIVE

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Allegation: Resident is being financially abused while in care. During the course of this investigation, LPA interviewed the Business Administrator, Executive Director, Assisted Living Director and R-1. Staff interviews revealed that this facility does not handle any monies for Residents. Staff interviews revealed that this facility has a Personal Property/Theft and Loss Policy and Procedures which states that Residents "are encouraged to keep no more than $50.00 cash at any time, Residents will be requested to keep fine jewelry and other items of value in a safe deposit box at their banking institution, no items of value will be entrusted to the community for safe keeping and no cash or other monies will be entrusted to the community and the community does not have a safe on premises to allow for safe keeping of residents' valuables (this facility provides all rooms with a lockable door to which the resident has a key for and/or a lockable cabinet inside their room. Interviewed staff indicated they have not heard nor have they observed anyone taking Residents monies. Interviewed staff indicated they are trained on mandated reporting and resident rights. R-1's file review revealed that R-1 has a trust management company handling R-1's financial affairs since November 2020. R-1 also confirmed that R-1 has a trust management company.

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

Exit interview conducted, a copy of this report and appeal rights were provided to the Executive Director.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC9099 (FAS) - (06/04)

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