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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603952
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:19:13 AM

Substantiated


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
07/14/2021 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20210714145302
FACILITY NAME:PROSPECT MANORFACILITY NUMBER:
197603952
ADMINISTRATOR:LYDIA PABIONFACILITY TYPE:
740
ADDRESS:800 PROSPECT AVETELEPHONE:
(626) 799-1141
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:99CENSUS: 53DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Lydia Pabion - Administrator TIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Resident was sexually abused while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Flores conducted a subsequent complaint visit. LPA met with Lydia Pabion and explained the reason for the visit. The purpose of today's visit is to deliver findings for LPA Irra who was assigned this complaint.

On 07/15/21, Licensing Program Analyst (LPA) Spencer conducted a Health and Safety check visit in response to the above personal rights allegation. LPA met with administrator Lydia Pabion. During this visit, LPA Spencer conducted a health and safety check and took a tour of the physical plant including the common areas, kitchen, dining room, medications room, and five (5) resident rooms. The facility was clean and in good repair and there were no observable signs of neglect, abuse or other immediate health and safety threats. LPA Spencer obtained a copy of staff roster, resident roster, and for three (3) specified residents: resident face sheet, MAR log, physician's report, and appraisal needs & services plan.

(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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 28-AS-20210714145302
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: 06/06/2023
NARRATIVE
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The investigation for this allegation was conducted by Investigator Dennis Seng.

During this investigation, IB Investigator Dennis Seng, conducted interviews with staff (including the suspect/Staff #1 (S1)), witnesses and Resident #1 (Victim/R1). It was determined that R1 was a victim of sexual abuse by S1 at the facility. R1 stated that the relationship between R1 and S1 was consensual “due to R1 being overly medicated on medication” during R1’s treatment for a medical condition. R1 indicated S1 hugged R1, fondled/sucked on R1’s breasts, and kissed R1 on R1’s lips during multiple occasions. S1 was also discovered by Staff #2 (S2) hiding inside R1’s closet without an explanation. S1 denied sucking/fondling R1’s breasts or that S1 engaged in any sexual activity/abuse; however, S1 admitted to hugging and kissing R1 on R1’s lips on several occasions. S1 admitted that S1 was caught in R1’s closet by S2 and stated that S1 hid in R1’s closet because S1 knew the situation “looked bad”. Facility staff became suspicious of S1’s relationship with R1 and asked S1 about it. S1 admitted he/she was in a relationship with R1 and forwarded facility staff text messages between S1 and R1. Due to the totality of the situation, S-1 statements, text messages exchanged between S-1 and R-1, S-1 hiding in R-1’s closet, and the lack of explanation to justify why S-1 was hiding in R-1’s closet, it was more than likely S-1 did fondle/sexually abused R-1.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 8 is being cited.



An immediate Civil Penalty of $500 is being issued today. Refer to LIC421IM. The issuance of an additional Civil Penalty is being assessed based on Health and Safety Code 1569.49(f) and could be issued at a later date.

Exit interview held. A copy of the report, LIC421IM, and Appeal Rights were provided to Lydia Pabion Administrator.

SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20210714145302
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2023
Section Cited
CCR
87468.1(a)(1)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This standard was not met as evidenced by:
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Administrator to provide all staff with personal rights training. Training plan will be submitted by 6/7/23. Proof of training will be submitted by 6/14/23. Immediate civil penalties assessed.
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S1 admitted to hugging and kissing R1 on R1’s lips on several occasions. S1 admitted being caught in R1’s closet by S2 and stated he/she hid in the closet because S1 knew the situation “looked bad”.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
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