197602744-3-5-2024-28-AS-DSIS-D3QN3R-20240326100645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602744
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:46:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/01/2024 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240301100923

FACILITY NAME:	TERRACES AT PARK MARINO, THE		FACILITY NUMBER:	197602744
ADMINISTRATOR:	MARIA TERESITA QUIZON		FACILITY TYPE:	740
ADDRESS:	2587 E. WASHINGTON BLVD.		TELEPHONE:	(626) 798-6753
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	112	CENSUS: 89	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Maria Quizon - Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident's diapering needs are not being met.
Staff mismanaged resident's money.
Staff did not ensure facility is kept free of hazards.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced 10-day complaint visit regarding the above allegations. LPA met with Maria Quizon, Executive Director and explained the purpose of the visit.

The investigation consisted of the following: LPA toured the facility focusing on the Memory Care unit common areas and hallways. LPA obtained copies of the Staff & Resident Rosters, Caregivers assignment sheets, Caregivers schedule, Charting notes and Altadena police report information (report #CUS0092, dated 03/01/2024). LPA conducted interviews with Staff #1 (S1) - Staff #8 (S8) and Resident #1 (R1) - Resident #8 (R8). Staff #9 (S9) was already off duty, therefore not interviewed. *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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-20240301100923

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TERRACES AT PARK MARINO, THE	FACILITY NUMBER: 197602744
	VISIT DATE: 03/05/2024

NARRATIVE

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The investigation reveals the following:

In regards to the allegation: “Resident's diapering needs are not being met.” It is alleged that the staff neglect on dressing patients and change for those incontinent residents, that incontinent residents don’t get changed every 1-2 hours which is mandatory and staff will wait until bed time. All the staff interviewed denied the allegation. Staff indicated that they have a regular routine and work assignments to follow. Staff stated that they do the rounds every 2 hours or 3x per shift or as necessary. Staff also indicated that they check with the residents throughout the day and before bed to ensure that the incontinent residents changing needs are being met. S1 stated that there is no reason to not change the residents diapers as they always have incontinent supplies available. S1 also stated that there was a police investigation on 3/01/2024 for similar allegations that has been concluded as police did not find any criminal activity. Interviewed residents denied the allegation and stated that staff are attentive to their needs and comply with what they ask for. The residents interviewed stated the staff check their diapers often and change them as needed and were staff never leave them sitting in soiled diapers. LPA reviewed documentation indicating that staff are doing their rounds as scheduled. During the tour, LPA observed sufficient incontinent supplies and did not observe incontinent odors in the facility, especially in the Memory Care unit. Documentation reviewed, interviews conducted with staff and residents and LPA observations do not corroborate this allegation.

In regards to the allegation: "Staff mismanaged resident's money." It is alleged that staff have been hiding the truth to residents about money going missing, and theft from residents and staff member. All staff interviewed denied the allegation. Staff indicated that they do not handle cash resources for residents. Staff stated that there was no report or complaint about theft or missing money or items recently. Staff stated that the last time they heard of a complaint about missing items was years ago. Interviewed residents cannot corroborate the allegation. 8 out of 8 residents interviewed stated that they have never lost any money or valuable items and have not heard other residents having this issue. Residents indicated that they feel safe leaving items in their rooms. Staff interviews and resident interviews do not corroborate this allegation.

****CONTINUED ON LIC9099-C*****

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240301100923

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: TERRACES AT PARK MARINO, THE	FACILITY NUMBER: 197602744
	VISIT DATE: 03/05/2024

NARRATIVE

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In regards to the allegation: "Staff did not ensure facility is kept free of hazards." It is alleged that staff ignore calls about safety hazards like moving items such as rugs or wheelchair from walk ways so patients won’t fall or trip. 8 out of 8 staff interviewed cannot corroborate the allegation. Staff stated that there was no falling or tripping incidents that happened in the facility in the recent months. Staff indicated that they discourage residents and their family to put rugs on top of their flooring due to safety hazard. Staff also indicated that residents always park their wheelchairs or walkers in their rooms or next to them in the dining area. S1 indicated that there was no recent report or complaint about safety hazards in the facility. 8 out of 8 residents interviewed denied the allegation. All residents interviewed stated that they feel safe in the facility and had never had any tripping or falling accident. Residents also indicated that they have not seen any obstruction in the hallway or common areas to cause them to trip or fall. During the tour, LPA did not observe any obstructions in the common areas or hallways. Staff interviews, resident interviews and observations do not corroborate this allegation.

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

Exit interview conducted and a copy of this report was provided to Maria Quizon, Executive Director.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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