197603952-8-16-2021-28-AS-MVAO-CAMPYY-20220113104443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 08/16/2021
Date Signed: 08/16/2021 02:38:28 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
06/28/2021 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20210628101748

FACILITY NAME:	PROSPECT MANOR		FACILITY NUMBER:	197603952
ADMINISTRATOR:	LYDIA PABION		FACILITY TYPE:	740
ADDRESS:	800 PROSPECT AVE		TELEPHONE:	(626) 799-1141
CITY:	SOUTH PASADENA	STATE: CA	ZIP CODE:	91030
CAPACITY:	99	CENSUS: 43	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	12:08 PM
MET WITH:	Lydia Pabion - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff engaged in inappropriate interactions with resident.
Facility staff is financially abusing resident.
Facility staff failed to safe guard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Mary Flores and Luis Mora conducted an unannounced complaint investigation visit for the above allegations. LPAs met with Lydia Pabion administrator and explained the reason for the visit.

The investigation consisted of the following: On 07/07/21, LPA Flores conducted a tour of the facility at 1:15pm which consisted of the common areas, kitchen, and random rooms #227, 210, 110, 107, 105 water temperature was tested in each room and tested between 77.6 to 114.5 degrees F which is not between the required 105 - 120 degrees F. LPA interview administrator and resident #1 (R1), and requested the following documents; Admission agreement, physician's report, medication sheet for June, any incident reports, face sheet for R1, resident #2(R2), #3(R3), #4(R4), #5(R5) and job description for staff #1 (S1), #2(S2), #3(S3), #4(S4), and staff and resident roster. LPA Flores interviewed pharmacist over the phone. On 7/29/21 LPA Flores conducted interviews with S1,S2,S3,S4,staff #5(S5), #6(S6). On 08/16/21, LPAs conducted interviews with resident #1 (R1),#2 (R2), #3 (R3), #4 (R4), #5(R5). (CONTINUED LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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-20210628101748

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: PROSPECT MANOR	FACILITY NUMBER: 197603952
	VISIT DATE: 08/16/2021

NARRATIVE

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The investigation revealed the following: Regarding allegation: Facility staff engaged in inappropriate interactions with resident. It is alleged staff has a “Crush on resident” and has bought gifts several times and offered to buy resident a cell phone. Interviews with residents revealed the following 4 out of 5 residents stated staff have not made inappropriate comments or had inappropriate interactions with residents and 1 out of 5 residents stated that staff wants to be involved in resident's affairs. Interviews with staff revealed 5 out of 6 staff stated staff are respectful and have not observed inappropriate behavior's with residents. 1 out of 6 staff stated that facility terminated a staff member due to inappropriate behavior with a resident. Administrator stated that there have not been additional concerns regarding other staff being inappropriate with residents. Based on LPA's, interviews, and file review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Regarding allegation: Facility staff is financially abusing resident. It is alleged facility billed resident stating that the bill is for medicine, however medications are covered through resident's medical insurance. Interviews with residents revealed 5 out of 5 residents stated facility has not billed residents with additional charges or requested money. Interview with staff revealed 6 out of 6 residents stated not to have heard residents state that they are being financially abuse by facility. Administrator stated some residents receive pharmacy bills as the co-payment for the medication order for residents. On 7/7/21 LPA Flores interviewed pharmacist from Specialist Medical Pharmacy, who stated that residents receive an invoice whenever medication order is not cover by medi-cal/medi-care and a fee must be charge and medication is requested by resident. Invoices are provided to the facility to be given to the residents. Based on LPA's interviews, and file review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Regarding allegation: Facility staff failed to safe guard resident's personal belongings. It is alleged that in October 2020 someone stole resident's cell phone. Interviews with residents revealed 4 out of 5 residents stated to not have had any items stolen from their rooms and 1 out of 5 residents stated to have had items missing from room. Interviews with staff revealed 6 out 6 staff stated to not have heard any residents say that items have been stolen from their rooms or from a resident. Administrator stated that a resident reported to have lost cellphone in the bus around December 2020.

Based on LPA's interviews, and file review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.
Exit interview was conducted with Lydia Pabion administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC9099 (FAS) - (06/04)

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