197603952-1-30-2023-28-AS-RORN-CPWNEF-20230314102353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 01/30/2023
Date Signed: 01/30/2023 12:34:02 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
01/24/2023 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20230124121154

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: 50	DATE:	01/30/2023
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Lydia Pabion- Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility staff not repairing broken heating system at facility.
Facility staff not meeting residents' needs for activities at facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Lydia Pabion Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested a copy of resident/staff roster, conducted a tour of facility's resident rooms #103,108,112,117,224,220,211,204, a total of 12 thermostats were observed throughout the facility's hallways next to the following rooms #104,107,111,119,232,227,220,216,212,208,201 all set up and read at 72 degrees F. except for thermostat next to room #107 read at 69 degrees F and set up at 72 degrees F., and thermostat next to room# 232 which was set up at 74 and read at 72 degrees F. Interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5) and staff #1(S1),#2(S2),#3(S3),#4(S4) and #5(S5). LPA Flores reviewed activity calendar for the month of January 2023, S3 duties and responsibilities sheets.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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-20230124121154

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: PROSPECT MANOR	FACILITY NUMBER: 197603952
	VISIT DATE: 01/30/2023

NARRATIVE

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The investigation revealed the following: Regarding allegation: Facility staff not repairing broken heating system at facility. It is alleged that the heating system at the facility is broken. Interviews with residents revealed 3 out of 5 residents interview stated temperature at the facility is good and has not been cold in their rooms and/or hallways. 1 out of 5 residents interviewed stated temperature in the room is cold in the evening and 1 out of 5 residents was unable to be interview due to cognitive skills. Licensee stated heating system has not been broken. Interview with staff revealed 5 out of 5 staff stated temperature is preset at 72 degrees F., during the winter. During the facility tour conducted LPA observed the temperature was set at 72 degrees around the facility. The lowest reading was 69 degrees F., the rooms around that thermostat felt the same as the rest of the facility temperature wise. All other rooms observed felt at a comfortable temperature. Room #204 was slightly colder than the rest of the facility. During the visit Maintenance person contacted A/C/Heater technician and the temperature in that area of the building was address to ensure it match the reading on the thermostat.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Facility staff not meeting residents' needs for activities at facility. It is alleged facility staff is not meeting residents' needs for activities at facility. Interviews with residents revealed 3 out of 5 residents stated activities are offered and residents are part of the activities such as: exercises, bingo, art, etc. 1 out of 5 residents stated not to participate in the activities and performs activities on their own. 1 out of 5 residents was unable to answer due to cognitive skills. Interviews with staff revealed 5 out of 5 staff interview stated activities are provided to the residents throughout the day by the activity director. LPA reviewed activity calendar for January 2023 and observed activities such as: lottery, art classes, bingo, going to the store, movies, birthday celebrations are schedule in the afternoon on different days of the week. Exercises are schedule in the morning daily.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Lydia Pabion Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC9099 (FAS) - (06/04)

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